Ambreen Moatasim - Academia.edu (original) (raw)

Papers by Ambreen Moatasim

International Journal of Surgery, Apr 1, 2013

Intraoperative evaluation of sentinel lymph nodes has become routine in many units that manage ea... more Intraoperative evaluation of sentinel lymph nodes has become routine in many units that manage early breast carcinoma. The procedure is associated with minimal morbidity and can be cost effective, avoiding re operation and reducing hospital stay as an axillary clearance can be performed under the same anesthetic after a positive intraoperative diagnosis without awaiting conventional paraffin histology. In negative cases extensive axillary lymph node dissection and its associated side effects can be avoided altogether. With careful patient selection, the expertise of surgeons and pathologists can increase the sensitivity and specificity of the technique with a reduction in false negatives. A number of international studies have established the usefulness of intraoperative sentinel lymph node evaluation. However, no local study has assessed the accuracy of frozen section in evaluating sentinel lymph node biopsy. The purpose of our study was to compare the two techniques (frozen section versus conventional paraffin histology) of the sentinel lymph node examination and to present our local data highlighting its usefulness and pitfalls, comparing the results with those in published studies. From the results obtained, we strongly recommend intraoperative assessment of the sentinel lymph nodes in breast carcinoma patients; frozen section microscopy can be a reliable and accurate technique in the hands of an experienced histopathologist.

… Journal of Pathology, 2004

Department of Pathology, Pakistan Institute of Medical Sciences, Islamabad. * Medical Student at ... more Department of Pathology, Pakistan Institute of Medical Sciences, Islamabad. * Medical Student at the Aga Khan University Hospital, Karachi. ... Introduction: Tuberculous lymphadenitis is one of the most common causes of lymphadenopathy. Fine needle aspiration cytology is the ...

Leiomyomas occur at various anatomical sites. While gastrointestinal leiomyomas are relatively un... more Leiomyomas occur at various anatomical sites. While gastrointestinal leiomyomas are relatively uncommon, the female genital tract leiomyomas are one of the most common benign tumors. It is important to rule out the possibility of leiomyosarcoma whenever examining leiomyomas. At times this may be quite taxing as the nuclear atypia may be minimal. Not only many sections have to be submitted but also each section has to be carefully scrutinized for mitotic counts. Even slightly increased mitotic counts have been associated with malignancy. On the other hand, there are occasionally tumors which despite having very high mitotic counts are benign. These tumors are clinically distinct and if proper attention is given diagnosis of malignancy in such cases can be avoided. We describe here a case of vaginal leiomyoma with high mitotic counts in which correct diagnosis was achieved with patience and proper consultation.

Cureus, 2022

Mucinous cystadenocarcinoma of the breast is a rare primary breast carcinoma having distinct clin... more Mucinous cystadenocarcinoma of the breast is a rare primary breast carcinoma having distinct clinical behavior and a favorable prognosis. It has a characteristic morphology that must be differentiated from metastatic ovarian and pancreatic mucinous adenocarcinoma. The etio-pathogenesis, genetic profile, and treatment of this tumor are controversial. Here, we report a case of primary mucinous cystadenocarcinoma of the breast in a 61-year-old female. The case is of interest since it is uncommon and has peculiar clinical and morphological features.

Introduction: Tuberculous lymphadenitis is one of the most common causes of lymphadenopathy. Fine... more Introduction: Tuberculous lymphadenitis is one of the most common causes of lymphadenopathy. Fine needle aspiration cytology is the most economical, quick and easy way of its diagnosis. Familiarity with cytological features of lymphadenopathy is essential in order to arrive at a correct diagnosis. Objective: The objective of the study is to describe the spectrum of morphological features seen on cytological smears of tuberculous lymphadenitis.

Cureus, 2022

Introduction Systemic amyloidosis can affect any organ in the body, but the kidney is the most co... more Introduction Systemic amyloidosis can affect any organ in the body, but the kidney is the most commonly involved site. It is characterized by the extracellular deposition of insoluble fibrillar proteins. Amyloid deposits can be identified histologically by Congo red stain, which gives apple-green birefringence under polarized light. Typing of renal amyloidosis is done by direct immunofluorescence on frozen tissue. The most common types of amyloidosis seen in renal tissue are amyloid light chain (AL) primary amyloidosis and amyloid A (AA) secondary amyloidosis. Although primary amyloidosis is considered the most common type in western countries, however, in the subcontinent region, secondary amyloidosis is more common. The spectrum of signs and symptoms in renal amyloidosis is variable including isolated proteinuria, nephrotic syndrome, hypertension, hypotension, and renal insufficiency. The present study aims to evaluate the incidence and aetiology of various types of renal amyloidosis, determine their distribution within the kidney, and study various clinicopathological features. Objective The present study aims to evaluate the aetiology and clinicopathological profile of renal amyloidosis, determine its various types, and their distribution within the kidney.

Ambreen Moatasim Abstract Hyperoxaluria is a rare condition characterized by excessive production... more Ambreen Moatasim Abstract Hyperoxaluria is a rare condition characterized by excessive production of urinary oxalate. The excess oxalate in combination with calcium deposits and damages various organs of the body especially kidney. We pre- sent here a case of five year old girl with history of recurrent renal stones leading to end stage renal disease. His- tological and chemical evaluation confirmed the clinical diagnosis of primary hyperoxaluria. Primary hyperoxaluria is a serious disorder leading to renal failure in childhood. An early diagnosis and treatment is mandatory to im- prove the overall prognosis of the disease.

Surgical and Experimental Pathology, 2021

Introduction Endometrial carcinoma is associated with several known prognostic factors. Recently,... more Introduction Endometrial carcinoma is associated with several known prognostic factors. Recently, lymphovascular invasion (LVI) has gained a prominent position in the risk assessment of early endometrioid endometrial carcinoma, in identifying patients who can benefit from adjuvant radiation therapy. This study aims to assess LVI in early-stage endometrioid endometrial carcinoma accurately with emphasis on its extent /grading. We also propose a few local recommendations for improving LVI reproducibility in endometrial carcinoma to guide future studies. Methods The duration of this retrospective study was 2 years. Early-stage I (Ia and Ib), and grade 1 and 2 endometrioid endometrial carcinomas were included. 03 reviewers independently recorded their findings on H&E stained slides. LVI was graded as none, focal and substantial. In discordant cases, immunohistochemical stain CD 31 was used. All the data was entered in the statistical software SPSS version 26 and analyzed for frequencies...

Human Pathology: Case Reports, 2020

Abstract Our case report describes a rare, spindle cell entity of mesenchymal origin arising in t... more Abstract Our case report describes a rare, spindle cell entity of mesenchymal origin arising in the kidney, incidentally detected on abdominal ultrasonography and computed tomography following complaints of hypertension, diabetes mellitus and right lumbar pain, in a 48 years old male patient. Right radical nephrectomy was performed. The detailed histopathological and immunohistochemical evaluation by experienced histopathologists at two sister institutes led to the diagnosis of a rare, extrapleural variant of solitary fibrous tumor (SFT) arising from the kidney. This case report emphasizes the importance of immunohistochemistry as an indispensable tool for confirming the diagnosis of rare renal tumors.

Rawal Medical Journal, 2009

We report a case of a carcinosarcoma of the uterus with rare and unusual features in an 82 year o... more We report a case of a carcinosarcoma of the uterus with rare and unusual features in an 82 year old female who presented with postmenopausal vaginal bleeding for two months.. Histopathology of surgical specimen revealed uterine carcinosarcoma with metastases to omentum. (Rawal Med J 2009;34:120-122).

JPMA. The Journal of the Pakistan Medical Association, 2012

To correlate the findings of immunoflorescence (IF) with morphology in renal biopsies of patients... more To correlate the findings of immunoflorescence (IF) with morphology in renal biopsies of patients with glomerulonephritis (GN) of both primary and secondary nature. The cross-sectional analytical study was conducted at the Shifa International Hospital's Department of Pathology form March 2007 to August 2008, during which a total of 207 renal biopsies were done. Of them, the study included 92 cases which were diagnosed as primary or secondary glomerulonephritis under light microscope. Those cases were selected in which both light microscopy (LM) and immunoflorescence were done. Of the 92 patients, 79 (85.8%) were adults (> or = 19 years) and 13 (14%) were children (< 19 years). The mean age of adults was 36.44 +/- 11.55 (range 19-69 years) and that of the children was 10.54 +/- 3.85 years (range 4-18 years). immunoflorescence changed the morphologic diagnosis in 20 (21.73%) cases. The pattern of disease was: membranous glomerulonephritis in 24%, focal segmental glomeruloscl...

JPMA. The Journal of the Pakistan Medical Association, 2011

Renal cell carcinomas (RCC) have been considered as a single entity, until recently. Today, howev... more Renal cell carcinomas (RCC) have been considered as a single entity, until recently. Today, however, these are not considered as a single tumour but instead represent various distinguishable entities, each having unique histology, cytogenetic and molecular features. The variants of renal cell carcinoma can be easily recognized histologically and hence one can identify tumours having similar clinical course, morphology, genetics, prognosis and possibly treatment. This descriptive study carried over a period of one and a half year at Shifa International Hospital, Islamabad, focuses on presenting our data of various variants of renal cell carcinoma and the need for their recognition as the correct diagnosis may help to modify the therapeutic protocol. During the study period a total of 13 cases of RCC were diagnosed with the clear cell variant as the most frequent type (n=9; 69.2%). There was one case each of chromophobe renal carcinoma, medullary carcinoma, mucinous tubular and spindl...

International journal of clinical and experimental pathology, 2008

Giant cell tumor of bone (GCTB) is a benign but locally aggressive bone tumor of young adults. It... more Giant cell tumor of bone (GCTB) is a benign but locally aggressive bone tumor of young adults. It typically presents as a large lytic mass at the end of the epiphysis of long bones. Grossly it is comprised of cystic and hemorrhagic areas with little or no periosteal reaction. Microscopically areas of frank hemorrhage, numerous multinucleated giant cells and spindly stromal cells are present. Telomeric fusions, increased telomerase activity and karyotypic aberrations have been advanced as a proof of its neoplastic nature. However such findings are not universal and can be seen in rapidly proliferating normal cells as well as in several osseous lesions of developmental and/or reactive nature, and the true neoplastic nature of GCTB remains controversial. The ancillary studies have generally not reached to the point where these alone can be taken as sole diagnostic and discriminatory criteria. While giant cells and stromal cells have been extensively studied, little attention has been p...

International journal of clinical and experimental pathology, 2008

Adult polycystic kidney disease (APCKD) is one of the most common serious inherited disorders. Ma... more Adult polycystic kidney disease (APCKD) is one of the most common serious inherited disorders. Many affected patients succumb to the renal and non-renal manifestations of this autosomal dominant disease. The disease is characterized by cyst formation in several organs, most obvious of which is in the renal parenchyma. Other features associated with the disease include hepatic fibrosis, hepatic, pancreatic and splenic cyst formation, Berry aneurysms, colonic diverticulae, hernias and cardiac valvular disorders. Rupture of Berry aneurysm is a sudden and often fatal manifestation in some unsuspected cases of APCKD. We recently examined one surgically removed kidney from a 15-year-old male patient with APCKD. In addition to the classical cystic change, extensive changes in renal parenchymal matrix and vasculature are also present. The excessive and weak matrix may contribute to dilatations of both renal tubules giving rise to cysts and the blood vessels. Our findings suggest that APCKD ...

Journal of Clinical & Experimental Pathology, 2014

Basal Cell Carcinoma (BCC) is the most common malignant skin tumor. Its diagnosis is made on clin... more Basal Cell Carcinoma (BCC) is the most common malignant skin tumor. Its diagnosis is made on clinical grounds followed by confirmation on histopathology. Fine Needle Aspiration Cytology (FNAC) can be reliably used to evaluate skin tumors especially BCC. Here a case of recurrent BCC of skin successfully diagnosed through FNAC is reported.

Leiomyomas occur at various anatomical sites. While gastrointestinal leiomyomas are relatively un... more Leiomyomas occur at various anatomical sites. While gastrointestinal leiomyomas are relatively uncommon, the female genital tract leiomyomas are one of the most common benign tumors. It is important to rule out the possibility of leiomyosarcoma whenever examining leiomyomas. At times this may be quite taxing as the nuclear atypia may be minimal. Not only many sections have to be submitted but also each section has to be carefully scrutinized for mitotic counts. Even slightly increased mitotic counts have been associated with malignancy. On the other hand, there are occasionally tumors which despite having very high mitotic counts are benign. These tumors are clinically distinct and if proper attention is given diagnosis of malignancy in such cases can be avoided. We describe here a case of vaginal leiomyoma with high mitotic counts in which correct diagnosis was achieved with patience and proper consultation.

We report a case of left ventricular myxoma metastasizing to blood vessels of extremities and cau... more We report a case of left ventricular myxoma metastasizing to blood vessels of extremities and causing cutaneous ulceration. Most of left ventricular myxomas are symptomatic (92.7%). Systemic embolism is the most common manifestation (50%) and often leads to death. 3 The propensity of cardiac myxomas to embolize is thought to be related to tumor morphology, with friable and gelatinous myxomas being more likely to embolize than firm and fibrous lesions. 26, 27 The current case is rare in the sense that the myxomatous material had metastasized to blood vessels of hands and legs, causing arterial insufficiency and hence cutaneous ulceration.

International Journal of Surgery, Apr 1, 2013

Intraoperative evaluation of sentinel lymph nodes has become routine in many units that manage ea... more Intraoperative evaluation of sentinel lymph nodes has become routine in many units that manage early breast carcinoma. The procedure is associated with minimal morbidity and can be cost effective, avoiding re operation and reducing hospital stay as an axillary clearance can be performed under the same anesthetic after a positive intraoperative diagnosis without awaiting conventional paraffin histology. In negative cases extensive axillary lymph node dissection and its associated side effects can be avoided altogether. With careful patient selection, the expertise of surgeons and pathologists can increase the sensitivity and specificity of the technique with a reduction in false negatives. A number of international studies have established the usefulness of intraoperative sentinel lymph node evaluation. However, no local study has assessed the accuracy of frozen section in evaluating sentinel lymph node biopsy. The purpose of our study was to compare the two techniques (frozen section versus conventional paraffin histology) of the sentinel lymph node examination and to present our local data highlighting its usefulness and pitfalls, comparing the results with those in published studies. From the results obtained, we strongly recommend intraoperative assessment of the sentinel lymph nodes in breast carcinoma patients; frozen section microscopy can be a reliable and accurate technique in the hands of an experienced histopathologist.

… Journal of Pathology, 2004

Department of Pathology, Pakistan Institute of Medical Sciences, Islamabad. * Medical Student at ... more Department of Pathology, Pakistan Institute of Medical Sciences, Islamabad. * Medical Student at the Aga Khan University Hospital, Karachi. ... Introduction: Tuberculous lymphadenitis is one of the most common causes of lymphadenopathy. Fine needle aspiration cytology is the ...

Leiomyomas occur at various anatomical sites. While gastrointestinal leiomyomas are relatively un... more Leiomyomas occur at various anatomical sites. While gastrointestinal leiomyomas are relatively uncommon, the female genital tract leiomyomas are one of the most common benign tumors. It is important to rule out the possibility of leiomyosarcoma whenever examining leiomyomas. At times this may be quite taxing as the nuclear atypia may be minimal. Not only many sections have to be submitted but also each section has to be carefully scrutinized for mitotic counts. Even slightly increased mitotic counts have been associated with malignancy. On the other hand, there are occasionally tumors which despite having very high mitotic counts are benign. These tumors are clinically distinct and if proper attention is given diagnosis of malignancy in such cases can be avoided. We describe here a case of vaginal leiomyoma with high mitotic counts in which correct diagnosis was achieved with patience and proper consultation.

Cureus, 2022

Mucinous cystadenocarcinoma of the breast is a rare primary breast carcinoma having distinct clin... more Mucinous cystadenocarcinoma of the breast is a rare primary breast carcinoma having distinct clinical behavior and a favorable prognosis. It has a characteristic morphology that must be differentiated from metastatic ovarian and pancreatic mucinous adenocarcinoma. The etio-pathogenesis, genetic profile, and treatment of this tumor are controversial. Here, we report a case of primary mucinous cystadenocarcinoma of the breast in a 61-year-old female. The case is of interest since it is uncommon and has peculiar clinical and morphological features.

Introduction: Tuberculous lymphadenitis is one of the most common causes of lymphadenopathy. Fine... more Introduction: Tuberculous lymphadenitis is one of the most common causes of lymphadenopathy. Fine needle aspiration cytology is the most economical, quick and easy way of its diagnosis. Familiarity with cytological features of lymphadenopathy is essential in order to arrive at a correct diagnosis. Objective: The objective of the study is to describe the spectrum of morphological features seen on cytological smears of tuberculous lymphadenitis.

Cureus, 2022

Introduction Systemic amyloidosis can affect any organ in the body, but the kidney is the most co... more Introduction Systemic amyloidosis can affect any organ in the body, but the kidney is the most commonly involved site. It is characterized by the extracellular deposition of insoluble fibrillar proteins. Amyloid deposits can be identified histologically by Congo red stain, which gives apple-green birefringence under polarized light. Typing of renal amyloidosis is done by direct immunofluorescence on frozen tissue. The most common types of amyloidosis seen in renal tissue are amyloid light chain (AL) primary amyloidosis and amyloid A (AA) secondary amyloidosis. Although primary amyloidosis is considered the most common type in western countries, however, in the subcontinent region, secondary amyloidosis is more common. The spectrum of signs and symptoms in renal amyloidosis is variable including isolated proteinuria, nephrotic syndrome, hypertension, hypotension, and renal insufficiency. The present study aims to evaluate the incidence and aetiology of various types of renal amyloidosis, determine their distribution within the kidney, and study various clinicopathological features. Objective The present study aims to evaluate the aetiology and clinicopathological profile of renal amyloidosis, determine its various types, and their distribution within the kidney.

Ambreen Moatasim Abstract Hyperoxaluria is a rare condition characterized by excessive production... more Ambreen Moatasim Abstract Hyperoxaluria is a rare condition characterized by excessive production of urinary oxalate. The excess oxalate in combination with calcium deposits and damages various organs of the body especially kidney. We pre- sent here a case of five year old girl with history of recurrent renal stones leading to end stage renal disease. His- tological and chemical evaluation confirmed the clinical diagnosis of primary hyperoxaluria. Primary hyperoxaluria is a serious disorder leading to renal failure in childhood. An early diagnosis and treatment is mandatory to im- prove the overall prognosis of the disease.

Surgical and Experimental Pathology, 2021

Introduction Endometrial carcinoma is associated with several known prognostic factors. Recently,... more Introduction Endometrial carcinoma is associated with several known prognostic factors. Recently, lymphovascular invasion (LVI) has gained a prominent position in the risk assessment of early endometrioid endometrial carcinoma, in identifying patients who can benefit from adjuvant radiation therapy. This study aims to assess LVI in early-stage endometrioid endometrial carcinoma accurately with emphasis on its extent /grading. We also propose a few local recommendations for improving LVI reproducibility in endometrial carcinoma to guide future studies. Methods The duration of this retrospective study was 2 years. Early-stage I (Ia and Ib), and grade 1 and 2 endometrioid endometrial carcinomas were included. 03 reviewers independently recorded their findings on H&E stained slides. LVI was graded as none, focal and substantial. In discordant cases, immunohistochemical stain CD 31 was used. All the data was entered in the statistical software SPSS version 26 and analyzed for frequencies...

Human Pathology: Case Reports, 2020

Abstract Our case report describes a rare, spindle cell entity of mesenchymal origin arising in t... more Abstract Our case report describes a rare, spindle cell entity of mesenchymal origin arising in the kidney, incidentally detected on abdominal ultrasonography and computed tomography following complaints of hypertension, diabetes mellitus and right lumbar pain, in a 48 years old male patient. Right radical nephrectomy was performed. The detailed histopathological and immunohistochemical evaluation by experienced histopathologists at two sister institutes led to the diagnosis of a rare, extrapleural variant of solitary fibrous tumor (SFT) arising from the kidney. This case report emphasizes the importance of immunohistochemistry as an indispensable tool for confirming the diagnosis of rare renal tumors.

Rawal Medical Journal, 2009

We report a case of a carcinosarcoma of the uterus with rare and unusual features in an 82 year o... more We report a case of a carcinosarcoma of the uterus with rare and unusual features in an 82 year old female who presented with postmenopausal vaginal bleeding for two months.. Histopathology of surgical specimen revealed uterine carcinosarcoma with metastases to omentum. (Rawal Med J 2009;34:120-122).

JPMA. The Journal of the Pakistan Medical Association, 2012

To correlate the findings of immunoflorescence (IF) with morphology in renal biopsies of patients... more To correlate the findings of immunoflorescence (IF) with morphology in renal biopsies of patients with glomerulonephritis (GN) of both primary and secondary nature. The cross-sectional analytical study was conducted at the Shifa International Hospital's Department of Pathology form March 2007 to August 2008, during which a total of 207 renal biopsies were done. Of them, the study included 92 cases which were diagnosed as primary or secondary glomerulonephritis under light microscope. Those cases were selected in which both light microscopy (LM) and immunoflorescence were done. Of the 92 patients, 79 (85.8%) were adults (> or = 19 years) and 13 (14%) were children (< 19 years). The mean age of adults was 36.44 +/- 11.55 (range 19-69 years) and that of the children was 10.54 +/- 3.85 years (range 4-18 years). immunoflorescence changed the morphologic diagnosis in 20 (21.73%) cases. The pattern of disease was: membranous glomerulonephritis in 24%, focal segmental glomeruloscl...

JPMA. The Journal of the Pakistan Medical Association, 2011

Renal cell carcinomas (RCC) have been considered as a single entity, until recently. Today, howev... more Renal cell carcinomas (RCC) have been considered as a single entity, until recently. Today, however, these are not considered as a single tumour but instead represent various distinguishable entities, each having unique histology, cytogenetic and molecular features. The variants of renal cell carcinoma can be easily recognized histologically and hence one can identify tumours having similar clinical course, morphology, genetics, prognosis and possibly treatment. This descriptive study carried over a period of one and a half year at Shifa International Hospital, Islamabad, focuses on presenting our data of various variants of renal cell carcinoma and the need for their recognition as the correct diagnosis may help to modify the therapeutic protocol. During the study period a total of 13 cases of RCC were diagnosed with the clear cell variant as the most frequent type (n=9; 69.2%). There was one case each of chromophobe renal carcinoma, medullary carcinoma, mucinous tubular and spindl...

International journal of clinical and experimental pathology, 2008

Giant cell tumor of bone (GCTB) is a benign but locally aggressive bone tumor of young adults. It... more Giant cell tumor of bone (GCTB) is a benign but locally aggressive bone tumor of young adults. It typically presents as a large lytic mass at the end of the epiphysis of long bones. Grossly it is comprised of cystic and hemorrhagic areas with little or no periosteal reaction. Microscopically areas of frank hemorrhage, numerous multinucleated giant cells and spindly stromal cells are present. Telomeric fusions, increased telomerase activity and karyotypic aberrations have been advanced as a proof of its neoplastic nature. However such findings are not universal and can be seen in rapidly proliferating normal cells as well as in several osseous lesions of developmental and/or reactive nature, and the true neoplastic nature of GCTB remains controversial. The ancillary studies have generally not reached to the point where these alone can be taken as sole diagnostic and discriminatory criteria. While giant cells and stromal cells have been extensively studied, little attention has been p...

International journal of clinical and experimental pathology, 2008

Adult polycystic kidney disease (APCKD) is one of the most common serious inherited disorders. Ma... more Adult polycystic kidney disease (APCKD) is one of the most common serious inherited disorders. Many affected patients succumb to the renal and non-renal manifestations of this autosomal dominant disease. The disease is characterized by cyst formation in several organs, most obvious of which is in the renal parenchyma. Other features associated with the disease include hepatic fibrosis, hepatic, pancreatic and splenic cyst formation, Berry aneurysms, colonic diverticulae, hernias and cardiac valvular disorders. Rupture of Berry aneurysm is a sudden and often fatal manifestation in some unsuspected cases of APCKD. We recently examined one surgically removed kidney from a 15-year-old male patient with APCKD. In addition to the classical cystic change, extensive changes in renal parenchymal matrix and vasculature are also present. The excessive and weak matrix may contribute to dilatations of both renal tubules giving rise to cysts and the blood vessels. Our findings suggest that APCKD ...

Journal of Clinical & Experimental Pathology, 2014

Basal Cell Carcinoma (BCC) is the most common malignant skin tumor. Its diagnosis is made on clin... more Basal Cell Carcinoma (BCC) is the most common malignant skin tumor. Its diagnosis is made on clinical grounds followed by confirmation on histopathology. Fine Needle Aspiration Cytology (FNAC) can be reliably used to evaluate skin tumors especially BCC. Here a case of recurrent BCC of skin successfully diagnosed through FNAC is reported.

Leiomyomas occur at various anatomical sites. While gastrointestinal leiomyomas are relatively un... more Leiomyomas occur at various anatomical sites. While gastrointestinal leiomyomas are relatively uncommon, the female genital tract leiomyomas are one of the most common benign tumors. It is important to rule out the possibility of leiomyosarcoma whenever examining leiomyomas. At times this may be quite taxing as the nuclear atypia may be minimal. Not only many sections have to be submitted but also each section has to be carefully scrutinized for mitotic counts. Even slightly increased mitotic counts have been associated with malignancy. On the other hand, there are occasionally tumors which despite having very high mitotic counts are benign. These tumors are clinically distinct and if proper attention is given diagnosis of malignancy in such cases can be avoided. We describe here a case of vaginal leiomyoma with high mitotic counts in which correct diagnosis was achieved with patience and proper consultation.

We report a case of left ventricular myxoma metastasizing to blood vessels of extremities and cau... more We report a case of left ventricular myxoma metastasizing to blood vessels of extremities and causing cutaneous ulceration. Most of left ventricular myxomas are symptomatic (92.7%). Systemic embolism is the most common manifestation (50%) and often leads to death. 3 The propensity of cardiac myxomas to embolize is thought to be related to tumor morphology, with friable and gelatinous myxomas being more likely to embolize than firm and fibrous lesions. 26, 27 The current case is rare in the sense that the myxomatous material had metastasized to blood vessels of hands and legs, causing arterial insufficiency and hence cutaneous ulceration.