Indian Journal of Pathology & Microbiology
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Item Correlation of P53 expression and epithelial-mesenchymal transition in non-small cell lung cancer(Wolters Kluwer - Medknow, 2025-06) Wu, Xiangmei; Duan, LijiangBackground: Investigation of a potential prognostic marker expressed innon?small cell lung cancer (NSCLC) can help patients benefit from newtarget therapeuticmodalities. Aims: To study the expression and correlationof P53 protein and epithelial–mesenchymal transition (EMT) relatedmakers in NSCLC. Materials and Methods: 32 cases were selected forimmunohistochemistry analysis to evaluate the expression of P53 andEMT?related makers. Results: The positive expression rate of P53 and theincidence of EMT in NSCLC were closely linked to TNM stages, differentiationdegree, and lymph node metastasis (P < 0.05). A positive association was foundbetween P53 and EMT (r = 0.380, P < 0.05). Conclusions: There is a positiveassociation between P53, snail, and EMT. P53 may affect EMT in NSCLC byup?regulating the expression of Snail and further promoting cancer invasionand metastasis.Item The NF1 gene mutations and co-mutations in lung adenocarcinomas with brain metastasis(Wolters Kluwer - Medknow, 2025-06) Kahraman-Cetin, Nesibe; Akin, Dilara; Orenay-Boyacioglu, Seda; Boyacioglu, Olcay; Erdogdu, Ibrahim Halil; Oktay, Esin; Meteoglu, IbrahimBackground: The co?occurrence of lung adenocarcinoma and brain metastasisremains a significant cause of morbidity and mortality despite advancements incancer treatment. The activity of neurofibromin, the product of NeurofibromatosisType 1 gene (NF1), is crucial in regulating the RAS/MAPK pathway. TheNF1 somatic mutations are significant in conditions such as melanoma, lungcancer, breast cancer, neuroblastoma, and central nervous system tumors.Objective: Therefore, this research aims to uncover the profile of NF1 mutationsand co-mutations in patients with brain metastases from lung adenocarcinoma,shedding light on their role in the pathophysiology of metastatic lung cancer.Materials and Methods: In this study, a total of 131 (31 females, 90 males)patients diagnosed with metastatic lung adenocarcinoma who were examined inthe Molecular Pathology Laboratory between 2019 and 2022 were retrospectivelyanalyzed. The NF1 somatic mutations and co-mutations were evaluated usingthe NGS lung panel on the MiniSEQ NGS platform. Results: The average ageof the 131 patients (31 females, 90 males) retrospectively examined in thestudy was 62.05 years. The ages of the cases included in the study followeda normal distribution according to Kolmogorov–Smirnov test (P = 0.200).Lymph node metastasis was detected in 48 patients (36.6%), while distantorgan metastasis was observed in 81 patients (61.83%). Metastases weremore frequently seen in males. No statistically significant difference was foundbetween metastases and gender (P > 0.05). Distant organ metastasis (n = 26,19.8%) and NF1 mutations (n = 8/26, 30.77%) were most commonly observedin the brain. The most common NF1 pathogenic variants in brain metastaseswere c.2325 + 3A > G (p.M1205fs*12) (n = 6/26, 23.07%) and c.1400C > T(p.T4671) (n = 5/26, 19.23%). There was no statistically significant relationshipobserved between patients’ age, gender, brain metastasis, and NF1 mutationtypes (respectively, P = 0.98, P = 0.63, and P = 0.87). The mutations that showedthe most association with NF1 mutations in brain metastases were PTEN andTP53. Conclusions: Somatic NF1 mutations and co-mutations can play acritical driving force in metastatic lung adenocarcinoma and may contribute totreatment resistance. The mutational landscape of somatic NF1 mutations andco-mutations can provide new insights into the pathophysiology of metastaticlung cancer, especially those that have metastasized to the brain.Item Protein expression of cancer stem cell markers ABCG2, podoplanin, and CD44 predicts early recurrence of oral squamous cell carcinoma: A study from Western India(Wolters Kluwer - Medknow, 2025-06) Trivedi, Trupti I.; Mandaliya, Toral H.; Trivedi, Priti P.Objectives: For oral squamous cell carcinoma (OSCC), we are likely at a juncturein clinical management, where the benefits of therapies are beginning to plateau.Therefore, this study investigated the usefulness of adenosine triphosphate(ATP)-binding cassette subfamily G member 2 (ABCG2), podoplanin (PDPN),and cluster of differentiation (CD) 44 (CD44) that may help to identify patientswith an aggressive phenotype and predict prognosis precisely. MATERIALSAND METHODS: The protein expression of ABCG2, PDPN, and CD44 wasinvestigated in 125 OSCC patients using immunohistochemistry and correlatedwith clinicopathological parameters and disease outcomes. The data wereevaluated using the Statistical Package for the Social Sciences (SPSS) software,and P value ?0.05 was considered significant. Results: The protein expressionof ABCG2, PDPN, and CD44 was noted in 56%, 43%, and 51%, respectively.ABCG2, PDPN, and CD44 show linear correlation with T3/T4 tumors, presenceof metastatic lymph nodes (LNs), and advanced-stage disease. Cox multivariateregression analysis for progression-free survival (PFS) demonstrated that inearly-stage patients, CD44 at step 1 (P = 0.007) followed by ABCG2 (P = 0.037) atstep 2 was associated with reduced PFS. For overall survival (OS), only ABCG2(P = 0.019) emerged as a potential parameter. Kaplan-Meier curves showedthat the combined signature of ABCG2 with PDPN for total patients, and ABCG2with CD44 for early-stage patients, emerged as more powerful risk predictorsfor identifying high-risk patients. Conclusion: Thus, the combined signature ofABCG2 with PDPN and CD44 could be useful in identifying high-risk patientsfor more aggressive therapy and effective personalized treatment in the future.Item High NUSAP1 expression predicts poor survival in laryngeal squamous cell carcinoma(Wolters Kluwer - Medknow, 2025-06) Zhou, Shengkai; Li, Haiyun; Zhang, Li; Chen, JinxiangObjective: Several studies have demonstrated that nucleolar spindle?associatedprotein 1(NUSAP1) can influence the biological behavior of malignant cells.However, the roles of NUSAP1 in laryngeal squamous cell carcinoma (LSCC)remain unknown. The purpose of this study is to analyze the NUSAP1 expressionand prognostic significance in LSCC patients. Materials and Methods: NUSAP1mRNA levels in laryngeal tissues were determined by qRT?PCR. Meanwhile,we examined the expression levels of NUSAP1 protein in 137 primary tumortissues and 20 cases of normal tissues by immunohistochemistry (IHC) analysison tissue microarrays (TMA). Results: Our results revealed that the frequencyof high NUSAP1 was significantly higher in cancer tissue compared to normalsurgical margins; NUSAP1 expression correlated with clinical features andoverall survival (OS). NUSAP1 overexpression was significantly associated withlymph node metastasis (P = 0.023) and TNM stage (P = 0.008); Kaplan?Meiersurvival curves revealed that patients with high NUSAP1 expression had worseprognoses than patients with low NUSAP1 expression. Conclusion: The datasuggested that NUSAP1 may be identified as a novel prognostic biomarker andtargeting NUSAP1 seems to be a novel strategy for LSCC treatment.Item Synchronous primary parotid tuberculosis and EBV-associated primary lymphoepithelial carcinoma(Wolters Kluwer - Medknow, 2025-06) Anbalagan, Anandhi; Jain, Deepti; Ravichander, Senthil KumarA 48?year?old gentleman presented with complaints of neck swelling in the parotid region for 2 years. Diagnostic nasal endoscopy and video laryngeal stroboscopy were normal, and positron emission tomography scan showed no other primary lesion. The lesion with tail of parotid was excised and sent for histopathological examination. Part of the tissue was also sent for diagnosis of tuberculosis by polymerase chain reaction (PCR) as it is a very common disease in South Asian countries. At this point, differentials considered were undifferentiated primary carcinoma, metastatic undifferentiated nasopharyngeal carcinoma, and primary lymphoepithelial carcinoma. At the same time, PCR for tuberculosis came positive with rifampicin sensitive in drug resistance testing. EBV by ISH testing came out to be positive. Final diagnosis of primary lymphoepithelial carcinoma with co?existing tuberculosis of parotid was made. The patient was started on antitubercular therapy.Item The curious case of subcutaneous dirofilariasis mimicking a fibroma – Report of a rare disease from North India(Wolters Kluwer - Medknow, 2025-06) Gupta, Latika; Kumar, SwadeshHuman dirofilariasis is a rare arthropod?borne zoonotic infection caused by a filarial nematode of the genus Dirofilaria. It typically manifests in humans as pulmonary, ocular, or subcutaneous lesions. In India, the disease is predominantly seen in the southern states, especially Kerala. Cases documented from India are mostly of ocular infection, and very few cases of subcutaneous dirofilariasis (SD) are reported. We hereby present a case of SD in a 25?year?old male, clinically diagnosed to have fibroma of the left forearm. Histopathology confirmed the diagnosis of SD. We present this case to reiterate that SD, though very rare in North India, should always be considered as a differential for subcutaneous swellings.Item Epidermal Growth Factor Receptor (EGFR) membranous and cytoplasmic overexpression on immunohistochemistry: An additional prognostic marker in oral squamous cell carcinoma(Wolters Kluwer - Medknow, 2025-06) Singh, Guddi Rani; Azad, Shabana; Singh, Tulika; Kumar, Manish; Sunny, Kumari; Sanehi, Divya; Haldar, DebadityaBackground: Oral carcinoma is one of the most frequently occurring cancersamong Indian men. We conducted this study to find out any associationbetween epidermal growth factor receptor (EGFR) overexpression byimmunohistochemical methods with histopathological prognostic parameters likepathological tumor (pT) staging, tumor grade, lymph nodal involvement, extranodalextension (ENE), perineural invasion (PNI), lymphovascular invasion (LVI), andworst pattern of invasion (WPOI). Materials and Methods: This prospectivecross?sectional study was conducted in Pathology Department of our institutebetween December 2021 and November 2022, and a total of 113 confirmedcases of oral squamous cell carcinoma (OSCC) were included in our study.Clinicopathological parameters were recorded, and EGFR expression byimmunohistochemistry was evaluated in these patients. The association of EGFRoverexpression and the different histopathological parameters according to theCollege of American Pathologists (CAP) protocol was determined. Results: Outof 113 cases, 52 cases (46%) were positive for EGFR overexpression onimmunohistochemistry. Significant association of EGFR overexpression wasnoted with pT stage, nodal status N0 versus N1–N2, ENE, PNI, LVI, and WPOI,with P value <0.05. No significant association was noted with tumor grade andnodal status N0–N1 versus N2–N3. Conclusion: EGFR overexpression canbe used as a prognostic marker in addition to histopathological parameters.One can opt for wedge resection in place of extensive surgery if small punchbiopsies show EGFR negativity and radiology shows uninvolved lymph nodes.In addition, in EGFR?positive OSCC cases, targeted therapy could be opted toavoid chemotherapy?related toxicity and increase patient survival.Item The curious case of light chain cast nephropathy in a renal allograft recipient(Wolters Kluwer - Medknow, 2025-06) Choudhury, Debarun; Chadha, Shiv; Gupta, Pallav; Malik, ManishMyeloma cast nephropathy in renal allograft recipients without pre?transplant diagnosis of multiple myeloma is rare. A 32?year?old hypertensive male presented to our institute as a prospective renal allograft recipient. Hemoglobin was 10.1 mg/dl. He did not have hypercalcemia, and the albumin/globulin ratio was 1.33. Urinalysis did not show any proteinuria or active sediments. Ultrasonography of the abdomen showed bilateral contracted kidneys. He underwent an uneventful renal transplant surgery and had immediate graft function. After 1 month, he tested positive for severe acute respiratory syndrome coronavirus 2 and developed graft dysfunction. Graft biopsy showed features of myeloma cast nephropathy. He had elevated lambda chains with an involved?to?uninvolved free light chain ratio of >100. Serum immunofixation electrophoresis showed a monoclonal band in the lambda region. Bone marrow biopsy showed plasmacytosis with 18.6% immature plasma cells. He improved on cyclophosphamide, bortezomib, and dexamethasone regimens.Item Meningothelial hamartoma of scalp mimicking encephalocele in an infant: A case report and review of literature(Wolters Kluwer - Medknow, 2025-06) Yadav, Amit Kumar; Belachew, Workalemahu A.An extremely rare benign lesion of the scalp is reported in a 2?month?old infant. The lesion had been present since birth. On examination, a 3 × 4 cm skin?colored soft mass over the occipital midline area was observed. On ultrasound, a diagnosis of occipital encephalocele was suggested. A complete excision of the mass was performed. Histological examination showed a subcutaneous lesion, which showed haphazardly arranged epithelioid cell nests admixed with connective tissue components, adipose tissues, and pseudovascular patterns within the deep dermis. Immunohistochemistry showed positive expression of Epithelial membrane antigen (EMA) and Vimentin. Tumor cells showed negative expression for Glial Fibrillary acidic protein (GFAP), chromogranin, S?100, Smooth muscle actin (SMA), and CD 34. Based on the clinical presentation, histologic features, and results of ancillary studies, a diagnosis of meningothelial hamartoma of the scalp was given. The clinical behavior of this lesion is benign but it often causes diagnostic confusion and may mimic malignant tumors. It is crucial to recognize the main features of this lesion.Item Potential liquid biopsy markers of exosomal microRNAs in renal interstitial fibrosis blood and urine(Wolters Kluwer - Medknow, 2025-06) Lv, Chunyan; Zhong, Yuan; Hu, Yao; Tang, YanObjective: To explore more and better liquid biopsy markers of exosomalmicroRNAs (exo?miRNAs) in renal interstitial fibrosis (RIF) and to preliminaryinvestigate the biological functions and signaling pathways involved in thesemarkers. Materials and Methods: High?throughput miRNA sequencing wasperformed on blood and urine exo?miRNAs from three RIF patients and threehealthy volunteers, and differential expression analysis and bioinformaticprocessing were performed. Results: There were 13 differentially expressedexo?miRNA (DEexo?miRNA) between RIF and healthy blood, and 20DEexo?miRNAs in urine. These were various DEexo?miRNAs in differentspecimens, and the former included PC?3p?213532_58, hsa?miR?338?5p_R?1,PC?5p?34127_410, pal?miR?9993a?3p_L+2R?1, and hsa?miR?26a?1?3pwith intermediate expression levels; the latter involved hsa?miR?126?3p,hsa?miR?217?5p, hsa?miR?199b?3p_R?1, mmu?miR?5106_R?4_1ss1AG, andPC?5p?39041_356, and others, while hsa?miR?378a?3p, hsa?miR?143?3p_R + 1 , h s a ? m i R ? 1 8 3 ? 5 p , h s a ? m i R ? 1 2 6 ? 3 p , h s a ? m i R ? 1 5 5 ? 5 p _ R ? 1 ,mmu?miR?5106_R?4_1ss1AG, hsa?miR?126?5p, and hsa?miR?199b?3p_R?1 hadhigh expression levels. Bioinformatics analysis of the up?regulated DEmiRNAwith high expression in urine showed that there are 291 target correspondingmRNAs for six of eight DEexo?miRNAs, with mmu?miR?5106_R?4_1ss1AGand hsa?miR?199b?3p_R?1 having no target gene found in TargetScan andmiRanda. GO annotation revealed that GO:0005515 (protein binding) had thelowest P value, involving the most genes. KEGG analysis revealed that thesignaling included the mTOR signaling pathway, autophagy ? animal, etc., andhsa05200 (pathways in cancer) had a lower P value, involving the most genes.Conclusions: Urine is a better sample for RIF exo?miRNA detection than blood.Urinary exosomal hsa?miR?143?3p_R+1, hsa?miR?183?5p, hsa?miR?126?3p,mmu?miR?5106_R?4_1ss1AG, hsa?miR?126?5p, and hsa?miR?199b?3p_R?1 arenovel liquid biopsy markers for RIF. These DEexo?miRNA may be associatedwith the occurrence and development of RIF and may participate in specificbiological processes by regulating the expression of their target mRNA. Furtherresearch may require exploring the specific functions and mechanisms of thesemiRNAs in RIF, as well as whether they can serve as diagnostic or therapeutictargets for RIF.Item Congenital dyserythropoietic anemia type II—A rare case report(Wolters Kluwer - Medknow, 2025-06) Sharma, Tejasvi; Vaswani, Shruti; Barman, Debasish; Didel, Siyaram; Purohit, AbhishekCongenital dyserythropoietic anemia type II (CDA II), initially described as hereditary erythroblastic multinuclearity with a positive acidified serum test (HEMPAS), is a rare genetic disease inherited in an autosomal recessive mode that presents with mild to severe anemia. The occurrence of this entity is quite uncommon and requires extensive work-up for a conclusive diagnosis. Here, we are reporting a case of two-year-old male child who presented with severe anemia, abdominal distension, and delayed milestones. Evaluation of bone marrow aspirate suggested the possibility of CDA which led to molecular work-up by whole exome sequencing with detection of c.1142C>T (p.Thr381lle) variant in SEC23B (NM_006363.6) gene.Item The unraveling of a rare case of prostate adenocarcinoma presenting as orbital mass(Wolters Kluwer - Medknow, 2025-06) Kadkol, Girish A.; Pol, Jaydeep N.; Ratnakar, Ashwini V.; Patil, Kunal U.Prostate adenocarcinoma (PC) is commonly known to have bone metastasis but its orbital metastasis is rare accounting for only 8.5% of cases. Most of the reported cases of orbital metastasis are in previously diagnosed PC cases. However, orbital metastasis as a sole manifestation of presentation is extremely rare, and to our knowledge, only three cases have been published similar to our present case. A 72?year?old male presented with diplopia and pain in the right eye for six months. On examination, right eye proptosis was noted. A computed tomography (CT) scan showed an enhancing, destructive soft tissue lesion involving the right orbit. The histopathological evaluation revealed a metastatic adenocarcinoma possibly of prostatic origin. Immunohistochemistry (IHC) confirmed the above diagnosis. We report this unique case of metastatic PC presenting with only ocular manifestation, emphasizing the crucial role played by diagnostic modalities like histopathology and IHC in unraveling such occult dilemmatic scenarios.Item Ependymosarcoma presenting as recurrence in a primary left parieto-occipital ependymoma(Wolters Kluwer - Medknow, 2025-06) Prasad, Pallavi; Baranwal, Harshita; Gupta, NeelimaEpendymomas are glial tumors that may arise from the supratentorial, posterior fossa, and spinal compartments. Conventional ependymomas belong to WHO grade 2. Gliosarcoma is described as a variant of IDH?wildtype glioblastoma, comprising a biphasic tissue pattern with alternating areas displaying glial and mesenchymal differentiation. It may develop in an ependymoma, in addition to astrocytomas. This sarcomatous transformation portends a more aggressive behavior; hence, this entity should be kept in mind during the management of lesions with atypical imaging features on diagnosis. We report a rare presentation of ependymosarcoma presenting nearly 1.5 years later after the excision of a conventional ependymoma in a young female. Upon presentation as recurrence, the patient developed symptoms and atypical imaging findings. Histopathological and immunohistochemical examination of the excised tumor specimens revealed sarcomatous change occurring in an operated prior conventional ependymoma.Item Karyomegalic interstitial nephritis, a fascinating histopathologic entity for pathologists: Be watchful of the FAN1 gene mutations(Wolters Kluwer - Medknow, 2025-06) Walia, Gurpreet K.; Vankalakunti, Mahesha; Akal, Ramanjit S.; Jha, Vijoy K.Karyomegalic interstitial nephritis (KIN) is an uncommon autosomal recessive disease, which is characterized by enlarged and hyperchromatic nuclei of the renal tubular epithelial cells. It is associated with mutations in Fanconi anemia?associated nuclease 1 gene, which is responsible for DNA repair, and these pathogenic mutations are responsible for progressive renal failure in young adults. We present a case of a 29?year?old female with end?stage renal disease who had a family history of early?onset renal failure in two of the siblings. Her elder sister with chronic kidney disease stage III was advised to be biopsied to look for any familial causes. Stained sections of renal biopsy revealed normal glomeruli. Tubular epithelial cells showed nuclear changes focally like hyperchromasia, karyomegaly, and anisonucleosis. On direct immunofluorescence, all glomeruli were negative for deposits with all antisera. Based on these findings, a final opinion of KIN was given.Item Renal allograft failure resulting from diffuse cortical necrosis(Wolters Kluwer - Medknow, 2025-06) Fernandes, Gwendolyn; Patil, Manali; Harinkhede, Nupur; Khumanthem, Gloria; Rojekar, AmeyCortical necrosis of the renal allograft is an extremely rare but serious complication of renal transplantation and can lead to graft failure. Few cases have been reported in the literature to date. We present a rare case of a 28?year?old woman with chronic kidney disease for the past four years who was on biweekly hemodialysis and referred to our tertiary care center for a living?related renal transplant. The patient developed tacrolimus toxicity on the second day post?transplant. The renal biopsy performed on third day after transplant showed ischemic acute tubular injury. C4d and donor?specific antibodies were negative. On day 12 post?transplant, USG Doppler of the renal allograft showed thrombosis of the renal vein, and an open wedge biopsy was performed that showed extensive renal cortical necrosis. A month and half later, the patient developed pus collection anterior to the transplanted kidney and a fistula from the perinephric space up to the skin with persistent pus discharge. Two months later, a graft nephrectomy was performed, and diffuse cortical necrosis of renal allograft with a thick band of exudate on the capsule was diagnosed on histopathology. Ureteral necrosis and thrombosis of both renal artery and renal vein were also seen. In this case, the etiology of graft cortical necrosis is multifactorial and includes acute ischemia, urologic complications, and sepsis. To prevent graft failures, it is critical to differentiate thrombosis caused by surgical complications from hyperacute or acute humoral rejection.Item An unusual case of scalp ulceration(Wolters Kluwer - Medknow, 2025-06) Gupta, Sonali; Singh, Poonam; Asati, Dinesh P.; Gowda, Shreya K.Granulomatosis with polyangiitis, a form of necrotizing vasculitis can present as a limited variant with the involvement of a single organ system. The superficial protracted form can present as face and scalp ulceration for chronic periods of time. Diagnosis can be established histopathologically by examining the involvement of blood vessels. Here, we present a case of scalp ulceration that was diagnosed as a limited variant and started on steroids and immunosuppressants with excellent response.Item Bing–Neel syndrome: A rare complication of waldenstrom macroglobulinemia(Wolters Kluwer - Medknow, 2025-06) Kudva, Ranjini; Monappa, Vidya; Menon, GirishCentral nervous system involvement is a rare complication of Waldenstrom macroglobulinemia (WM) accounting for 1–2% cases. This syndrome is called Bing–Neel syndrome (BNS) after the people who first described it in 1936. Although WM has a good prognosis, with the onset of this syndrome, most patients fare poorly with a high mortality rate. A 77/male, a known case of WM, presented with left upper limb weakness of 2 weeks duration. Magnetic resonance imaging brain showed diffuse pachymeningeal thickening along bilateral frontoparietal convexity. Biopsy showed lymphoplasmacytic lymphoma favoring a diagnosis of BNS. The patient was started on chemotherapy (rituximab + ibrutinib). At 3 months following diagnosis, the patient was admitted with Gram?negative septicemic shock and failed to recover from it. BNS is a rare complication of WM, associated with poor prognosis and an aggressive clinical course. It can occur during the course of treatment of WM, as was seen in this case. Accurate diagnosis with appropriate treatment plays a crucial role in patient management.Item Primary tumor lymphangiogenesis in oral squamous cell carcinoma with N0 neck is the key determinant of its therapeutics(Wolters Kluwer - Medknow, 2025-06) Tandon, Ankita; Sandhya, Kumari; Singh, Narendra N.; Kumar, AmitBackground: Vascular Endothelial Growth Factor?C (VEGF?C) plays a criticalrole in tumor growth and invasion through lymphangiogenesis and helps to identifythe variability of lymphatic potential of oral squamous cell carcinoma (OSCC)cases with or without lymph node metastasis. Materials and Methods: A total of65 cases of OSCC were included. The clinical details were obtained from patientrecords. The cases were grouped as N0 versus any N categories. All the caseswere immunohistochemically evaluated for VEGF?C within the primary tumorusing a standard protocol. An average of 5 lymph nodes were dissected fromall neck dissection specimens and were evaluated histopathologically. The dataobtained were statistically evaluated at 95% confidence interval and P ? 0.05.Results: 100% cases in our study showed VEGF?C immunopositivity. Theimmunoreactivity increased linearly with advancing grades. A total of 31 outof 40 N0 OSCC revealed score 2 (26%–50%) of VEGF?C immunoreactivity.Eighteen cases were false negative clinically. Conclusion: Recognition oflocoregional spread may empower clinicians for correct therapeutic decisionsin N0 versus any N case.Item Minocycline-induced drug reaction with eosinophilia and systemic symptoms (DRESS) masquerading as acute leukemia(Wolters Kluwer - Medknow, 2025-06) Gupta, Devika; Singh, Kanwaljeet; Dhaka, Ankit; Sengupta, PrasantaDrug reaction with eosinophilia and systemic symptoms (DRESS) is an idiosyncratic drug reaction characterized by fever, rash, and lymphadenopathy associated with atypical lymphocytosis and eosinophilia. Visceral organ involvement is also seen and hence it often mimics hematolymphoid malignancies. A 19?year?old girl presented with generalized pruritic rash, fever, lymphadenopathy, and lymphocytosis. Subsequently, she developed respiratory distress with a fall in SpO2. Flow cytometry, bone marrow studies, and infectious workup were normal. Skin biopsy and clinical assessment criteria established the diagnosis of DRESS secondary to minocycline intake. Discontinuation of the offending drug is most important to abet the hypersensitivity reaction. Visceral organ involvement requires the use of steroids and immunosuppressive agents. Our patient responded well to treatment and is presently symptom?free and on follow?up for the last 6 months.Item Primary pulmonary angiosarcoma was misdiagnosed as IgG4-related disease by needle biopsy: A challenging case report(Wolters Kluwer - Medknow, 2025-06) Wei, Shufei; Han, Yongliang; Hou, Yingyong; Hu, JialiAngiosarcoma is a rare soft tissue sarcoma. Primary angiosarcoma of the lung is even rarer. This case presents a patient with hemoptysis for 3 months. A chest computed tomography (CT) showed multiple patches of nodules with peripheral exudates distributed along the vascular bundles in both lungs, and the biopsy suggested IgG4 disease. However, the hemoptysis worsened for 3 days, and the patient underwent partial resection of the left upper lung, revealing eight masses of 0.5–2 cm in diameter. The tumor was composed of spindle, round, or polygonal cells arranged in bundles or sheets, and tumor cells were positive for vascular tumor markers. The patient was treated with six cycles of paclitaxel combined with gemcitabine chemotherapy, reducing the volume of the masses and improving hemoptysis.