Indian Journal of Pathology & Microbiology
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Item Alteration of gastric microbiota in Helicobacter pylori- infected individuals suffering from gastroesophageal reflux disease, duodenal ulcer, and gastritis(Wolters Kluwer - Medknow, 2025-03) Sharma, P; Singh, S; Singh, AV; Das, K; Bhaskar, Y; Goel, I; Singh, H; Das, RBackground/Aim: Helicobacter pylori (H. pylori) colonization affects the gastric microbiome, causing gastrointestinal (GI) diseases. Modern sequencing technology provides insights into GI microbe interaction with H. pylori and their metabolic pathways in causing GI diseases. We aim to compare the gastric microbiota alteration due to H. pylori infection in patients suffering from GI diseases. Materials and Methods: Genomic DNA were isolated from gastric antrum tissue from 37 H.pylori?infected patients diagnosed with GERD, duodenal ulcers, and gastritis. We conducted the genomic library preparation and sequencing of the amplified product using 16S rRNA NGS analysis. Using microbiome analyst tool diversity analysis, random forest analysis and ANOVA were conducted to find out the comparison of microbial abundance. We have also conducted functional pathway prediction analysis using PICRUSt. Results: Metagenomic analysis shows high bacterial diversity in H. pylori?positive gastritis patients. Streptococcus infantis and Neisseria subflava were significantly higher in duodenal ulcer (DU) and gastritis groups. Acinetobacter lwoffii and Helicobacter pullorum were significantly high in the gastritis group only. The functional metabolic pathway analyses revealed that gastroesophageal reflux disease (GERD) samples were significantly enriched with the energy metabolism and xenobiotic biodegradation and metabolism pathways, whereas fructose?1,6?bisphosphatase III was found less in gastritis and DU groups. Conclusion: There is a difference in microbiota composition in different disease outcomes. We found positive association between microbial diversity and H. pylori in gastritis group only, whereas negative association was found in DU and GERD groups. The functional metabolic pathway analysis revealed significant differences in various disease outcomes.Item High prevalence of cagA positive Vac A s1m1 Helicobacter pylori strains isolated from patients suffering from various gastroduodenal diseases in Guwahati, Assam, India(Wolters Kluwer - Medknow, 2025-03) Mahant, S; Singh, S; Dutta, S; Sharma, N; Das, PAim and Background: Genotyping of H. pylori strains was identified on formalin?fixed paraffin wax?embedded tissue (FFPE) sections and correlated with severity grades of gastric mucosal pathologies in biopsies from upper gastrointestinal (UGI) tract from Guwahati, Assam. Materials and Methods: In total, 168 gastric biopsies collected from patients with UGI symptoms underwent histological evaluation as per the updated Sydney system. Result: H. pylori?like organisms were identified with Warthin and Starry stain, and virulent genes were amplified using polymerase chain reaction (PCR) from genomic DNA extracted from FFPE sections by using QIAamp® DNA FFPE Tissue Kit. Histological examination identified H. pylori?like organisms in 100 biopsies, of which 96 were urease + ve. The prevalence of H. pylori infection was high in age groups 71–80 (88.8%) as compared to other age groups, and it was higher in females (78.9%) when compared to males. The prevalence of virulent genes in biopsies was 88.5% cagA and vacA s1m1, 31.2% iceA1, 32.2% iceA2, and 85.2% babA2. The histological parameters mononuclear cell infiltrate (P = 0.04) and atrophy (P = 0.03), showed statistically significant association with iceA2 and intestinal metaplasia with cagA (P = 0.01) vacAs1m1 (P = 0.01) and babA (P = 0.02) genotypes. Gastric erosion due to H. pylori infection and atrophy showed a significant association. A high bacterial density score was seen with the virulent genotypes. Conclusion: Our work reports for the first time a high prevalence (88.5%) of H. pylori cagA vacA s1m1 genotype in Guwahati, Assam. Association of gastric atrophy and intestinal metaplasia was seen with virulent genotypes. Results show the effectiveness of the FFPE kit for DNA extraction in remote areas where transportation and storage of biopsies are otherwise difficult.Item Compositional characteristics of the gut microbiome in patients with uremia(Wolters Kluwer - Medknow, 2025-03) Wu, Z; Bian, M; Zhang, H; Wang, M; Wang, P; Shao, Y; Shen, L; Zhu, GDuring acute or chronic uremia, the cumulative harmful effects of uremic toxins result in numerous health problems and, ultimately, mortality. Previous research has identified that uremic retention solutes originate from the gut microbiome, indicating that uremia may be closely associated with gut microbiome dysbiosis. To deepen our understanding of the compositional characteristics of the gut microbiome in patients with uremia and thereby promote precision medicine in the treatment of uremia, we conducted a study of the compositional characteristics of the gut microbiome in 20 patients with uremia. The gut microbiome diversity of uremic patients and the control group showed certain differences. Nonmetric multidimensional scaling analysis showed that the beta diversity of the gut microbiome of uremic patients was significantly different from that of the healthy control individuals, with a distinct clustering effect in the uremic patient group, and it also showed a similarly distinct clustering effect in the healthy control group. The Chao1 index and Sobs index were significantly lower in the uremic patient group than in the healthy control group (P < 0.05). By analyzing the composition and abundance distribution of the gut microbiome in the uremic patient group and healthy control group, we found that the relative abundance of the gut microbiome constituents Fusobacteriota, Enterobacteriaceae, Oscillospirales, Ruminococcaceae, and Lachnospiraceae was significantly increased in the intestines of uremic patients. We also detected the rare taxa Erysipelotrichaceae, which was present only in the uremic patient group. Predictive functional analysis suggested that an increased abundance of Ruminococcaceae and Lachnospirales, which are associated with indoxyl sulfate and phenylacetyl glutamine, and an increased abundance of Oscillospirales, which is associated with pyruvate metabolism, in uremic patients may strongly influence the gut environment according to renal function, resulting in dysbiosis associated with uremic toxin production. Rare taxa such as Erysipelotrichaceae have been suggested to be detrimental to intestinal disease. Further research into these gut microbiomes may provide new ideas for the prevention and treatment of uremia with the gut microbiomeItem Association between PD-L1 expression with EGFR, ALK, and ROS1 driver oncogene mutations in non-small cell lung cancer(Wolters Kluwer - Medknow, 2025-03) Onur, D; ?lhan, Y; Büge, Ö.Background: Driver mutations and immunological expressions have gained importance in recent years for targeted therapies and immunotherapies of nonsmall cell lung cancer (NSCLC). Aims: This study examined the association between PD?L1 expression and ALK, ROS1, and EGFR driver oncogene mutations in patients with NSCLC. Materials and Methods: A total of 501 NSCLC patients were included for analysis. Immunohistochemistry was performed with a PD?L1 clone 22c3. EGFR mutations were detected by PCR. ALK and ROS1 rearrangement analysis was performed with FISH. Results: There was a highly statistically significant difference between PD?L1 expression and EGFR mutation. PD?L1 expression was higher in the EGFR wild?type than in mutated EGFR (P = 0.0002). There was no relationship between PD?L1 expression and ALK and ROS1 mutations (P = 0.8899, P = 0.2512, respectively). PD?L1 expression was higher in nonadenocarcinomas (non?AC) than in adenocarcinomas (AC) (P = 0.0438). The ALK rearrangement and EGFR mutations were higher in ACs (P = 0.0073, P = 0.0012, respectively). ALK, ROS1 rearrangements, and EGFR mutations were higher in nonsmokers (P<0.05). EGFR mutations were detected more frequently in females than males (P = 0.001). There was no relationship between gender and ALK, ROS1, and PD?L1 (P > 0.05). The prevalence of EGFR, ALK, and ROS1 driver mutations in the Turkish population was 9.3%, 5.3%, and 2.4%, respectively. Conclusions: In conclusion, PD?L1 expression and mutated EGFR status have a highly negative association. PD?L1 expression was higher in EGFR wild?type patients. Therefore, it shows that the opportunity to receive PD?L1?related treatment may be higher in these patients. We think that PD?L1 immunohistochemical evaluation will increase the clinical predictive importance in EGFR wild?type cases.Item Dedifferentiated solitary fibrous tumor of submandibular gland(Wolters Kluwer - Medknow, 2025-03) Hasyim, NA; Juneja, M; Abraham, MT; Kallarakkal, TGItem Epstein-Barr virus (EBV) DNAemia in saliva of viral encephalitis and nasopharyngeal carcinoma patients(Wolters Kluwer - Medknow, 2025-03) Srinivasan, N; Barani, R; Manickavasagan, M; Srikanth, PEpstein?Barr virus (EBV) is a lymphotropic virus that causes diseases ranging from a flu?like illness called infectious mononucleosis to nasopharyngeal carcinoma, Burkitt’s lymphoma, and central nervous system (CNS) infection. Detection of EBV DNA is usually done using whole blood samples taken from the patients. We undertook the detection of EBV in blood, cerebrospinal fluid (CSF), and saliva by real?time quantitative PCR in two patients, one with a history of nasopharyngeal carcinoma, and the other having a case of viral encephalitis. EBV was detected only in saliva, whole blood in both patients, and CSF in the second case tested negative. This case series illustrates the importance of testing for EBV DNAemia in saliva by real?time polymerase chain reaction (PCR) to rule in a diagnosis of EBV.Item The immunohistochemical expression of c-MET and RON in lung adenocarcinoma with clinicopathologic correlation(Wolters Kluwer - Medknow, 2025-03) Kim, YA; Sung, WJBackground: Mesenchymal epidermal transition (MET) and receptor originating from nantes (RON) are transmembrane tyrosine kinase receptors. Both are members of a proto?oncogene family and thus play a role in the pathogenesis of various cancers and acquired resistance to kinase inhibitors in lung cancer. Aims: The aim of this study was to investigate the immunohistochemical expression of c?MET and RON in lung adenocarcinoma and its clinicopathologic correlation. Settings and Design: Retrospective study. Materials and Methods: The immunohistochemical c?MET and RON expression in specimens obtained from lung adenocarcinoma (n = 175) and associated clinicopathologic parameters were evaluated. Statistical Analysis Used: The correlation between c?MET and RON expression was analyzed by Chi?square test. A Cox proportional hazards model and Kaplan?Meier curve analysis were used to evaluate the risk factors and prognosis. Results: High expression of the c?MET protein showed a strong correlation with that of RON (P = 0.013, kappa = 0.183). Five?year survival and recurrence?free 5?year survival were not associated with high expression of c?MET or RON. High c?MET expression was significantly associated with age older than 60 years (P = 0.000), tumor differentiation (P = 0.009), lymphovascular invasion (P = 0.016), and pleural invasion (P = 0.005). High RON expression was associated with a solid growth pattern (P = 0.001) and pleural invasion (P = 0.002). Conclusions: The results point to the potential of immunohistochemical expression of c?MET and RON as useful prognostic markers of unfavorable histopathologic features in lung adenocarcinoma.Item A serious warning: A case report on localized amyloidosis of the oral cavity(Wolters Kluwer - Medknow, 2025-03) John, S; Subba, P; Aramugam, A; Gupta, S; Khanna, RAmyloidosis is a relatively rare condition with an array of complex pathophysiology. Localized amyloidosis is a rare and benign condition that practically never results in any clinical repercussions in the head and neck area. Multiple soft nodules of the tongue, lip, and cheek are the most commonly described defining characteristics of localized oral amyloidosis. These nodules originate due to the proliferation of abnormally folded protein aggregates in the body’s extracellular tissue compartments, which destroy organ structure and function. Herein, we address the case of a female infant aged one with a smooth nodule in the labial mucosa who was diagnosed with primary localized amyloidosis. When a patient is diagnosed with amyloidosis of the oral mucosa, the possibility of systemic amyloidosis or an underlying plasma cell dyscrasia must be ruled out. Surgical treatment may be beneficial for eliminating any functional impairment if primary localized amyloidosis is established.Item Primary bone solitary B-cell lymphoblastic lymphoma aberrant expression Fli-1 and ERG: A case report(Wolters Kluwer - Medknow, 2025-03) Chen, H; Li, JS; Huang, YPrimary non?Hodgkin bone lymphoma is a rare disease, and within this category, B?cell lymphoblastic lymphoma (B?LBL) is an even rare clinical entity that has only been reported in small case series or individual case reports. B?LBL can mimic Ewing’s sarcoma both clinically and histologically, leading to misdiagnosis. We present a case of primary B?LBL of the bone in a 7?year?old girl. The tumor cells are uniform and small with a diffuse and infiltrative growth pattern similar to EWS. Immunohistochemical results are positive for CD99, Fli?1, ERG, TDT, PAX5, and CD79?, but negative for leukocyte common antigen, CD3, CD20, and NKX2.2. No other lesions are found on positron emission tomography/ computed tomography imaging. Finally, primary solitary bone B?LBL of the right tibia was diagnosed.Item Lipoblastoma of the lip(Wolters Kluwer - Medknow, 2025-03) Cota, J; Borkar, RR; Savalkar, JJ; Chalakkal, P; Spadigam, ALipoblastomas are benign tumors arising from embryonic white fatty cells that continue to proliferate and develop during the postnatal period. It commonly affects children 3 years of age or younger, with the neck being the most frequent site in the head and neck region. Only 10% of cases are seen at 10 years or above. The etiopathogenesis of lipoblastomas is linked to polysomy and rearrangement of chromosome 8q11–13 with or without the involvement of the pleomorphic adenoma gene 1 (PLAG1) gene. Here, we report one of the first cases of lipoblastoma of lip in a 10?year?old boy with atypical immunohistochemical features and the need for thorough clinical and histopathological evaluation of cases with atypical findings. The novel pathogenetic mechanism of lipoblastoma from the cluster of differentiation 34?positive (CD34+) stem cells has also been discussed.Item Anti-phosphohistone H3 (PHH3) as a proliferation marker to assess mitotic activity and to grade neuroendocrine neoplasms of hepatopancreaticobiliary (HPB) system(Wolters Kluwer - Medknow, 2025-03) Santhanam, AP; Joel, A; Paul, A; Zachariah, UG; Rebekah, GJ; Kodiatte, TABackground: The world health organization (WHO) classification of neuroendocrine neoplasms (NENs, i.e. neuroendocrine tumors (NETs) and neuroendocrine carcinomas (NECs)) of the gastrointestinal system involves grading of these tumors by mitotic count (i.e. H and E mitotic index or Haematoxylin and Eosin mitotic index [HE?MI] and Mindbomb E3 ubiquitin protein ligase 1 labelling index (MIB1?LI) into Grade 1 (G1), Grade 2 (G2), or Grade 3 (G3). However, the assessment of HE?MI and MIB1?LI is hindered by several factors that contribute to discordance between these two grading methods. Clinical data demonstrate the dependency of prognosis on grade. Objectives: The objective of this study was to compare the grading of NENs of the hepatopancreatobiliary (HPB) system using Anti-phosphohistone H3 mitotic index (i.e.PHH3?MI), HE?MI and MIB1?LI. Materials and Methods: In a cohort of 140 NENs selected from January 2011 to August 2019, the concordance and correlation between HE?MI, MIB1?LI and PHH3?MI grading methods were analysed using Cohen’s weighted kappa (?) statistics and Spearman’s correlation (?), respectively. Receiver operating characteristic (ROC) curve and cut?off analyses were done to determine optimal PHH3?MI cut?off values to grade NENs. Results: The rates of discordance between HE?MI vs. MIB1?LI, PHH3?MI vs. MIB1?LI and PHH3?MI vs. HE?MI were 52% (? =0.416), 29% (? =0.64) and 41% (? =0.508), respectively. There was a significant correlation between the grading methods. PHH3?MI had good overall sensitivity and specificity at cut?offs 2 and 17 in distinguishing between G1 vs. G2, and G2 vs. G3 tumors, respectively. Conclusion: PHH3 immunolabeling allowed for quick and easy identification of mitotic figures (MF). It had the highest concordance with MIB1?LI. At cut?off values of 2 and 17, there was good overall sensitivity and specificity. The interobserver agreement was excellent.Item Crystallizing galactocele: A rare case report and review of literature(Wolters Kluwer - Medknow, 2025-03) Verma, N; Gaur, N; Awasthi, S; Bajaj, V; Sharma, S; Mahajan, SCrystallizing galactocele is an uncommon condition that produces a viscous, chalky substance on fine needle aspiration cytology. (FNAC). Both the diagnosis and the management of this illness include the use of FNAC. Here, we discuss the case of a 25-year-old nursing woman who experienced left breast edema lump for two years. The upper outer quadrant of the leftt breast was involved by the hard, small, non-tender, and movable enlargement. The lesion's FNAC produced a thick, milky, and chalky substance. Numerous semi-transparent crystals of various sizes and shapes with angulated edges could be seen in cytological smears against a background of granular and amorphous proteinaceous material. A diagnosis of crystallizing galactocele was made on the basis of the patient's clinical history of lactation and characteristic cytological findings. Due to the rarity of this condition—to the best of our knowledge, less than ten cases of crystallizing galactocele have been documented in medical literature.Item Staphylococcal scalded skin syndrome in neonate: Another face of CA-MRSA(Wolters Kluwer - Medknow, 2025-03) Rizwana, MM; Shanmugapriya, S; Sudha, MJ; Appalaraju, B; Ramesh, SStaphylococcal scalded skin syndrome (SSSS), also known as Ritter’s disease, in its severe form occurs predominantly in infants and children. It is caused by infection with group II (often phage group 71) Staphylococcus aureus. The foci of infection include nasopharynx, less commonly umbilicus, urinary tract, superficial abrasion, conjunctivae, and blood. Staphylococci are non?motile, non?spore?forming, catalase?positive, gram?positive cocci that appear predominantly as grape?like clusters. Although this organism is frequently a part of normal human microbial flora, it can cause significant opportunistic infections under certain conditions such as when extremes of age groups are involved, the presence of indwelling medical devices, and intravenous (iv) drug abuse. Staphylococcus aureus may cause a variety of infectious manifestations ranging from relatively benign skin infections to life?threatening systemic illnesses. SSSS caused by S. aureus strains produces exfoliative toxins which result in the development of blisters, erythema, and desquamation. Here, we present a case of an 11?day?old neonate who was diagnosed with SSSS. The causative agent responsible for this syndrome was identified as methicillin?resistant Staphylococcus aureus (MRSA). The molecular characterization of the gene Panton?Valentine leukocidin (PVL) was done by polymerase chain reaction (PCR) and was detected positive for PVL which is a distinctive virulence factor seen almost in all of the community?acquired MRSA strains. The patient was discharged after parenteral clindamycin therapy with almost complete resolution of symptoms.Item Micronodular thymoma with lymphoid stroma: As benign as it sounds(Wolters Kluwer - Medknow, 2025-03) Chaudhary, K; Gala, R; Mehta, JMicronodular thymoma (MNT) is a rare subtype of thymoma (reported incidence is approximately 1–5%). We report a case received as a core biopsy from the “right lung mass” of a 31?year?old female. CT scan showed an 8.1 cm large well?defined mass lesion in the right middle lobe, causing indentation and mild compression of the right atrium. Microscopically, the biopsy showed a thymic neoplasm comprised of multiple discrete and coalescing nodules of bland epithelioid tumor cells separated by an epithelial cell?free lymphocyte?rich stroma. On immunohistochemistry, cytokeratin highlighted the thymic epithelial cells. The lymphoid cells showed a naive T?cell phenotype (TdT+ CD 3+). It is worthwhile recognizing this rare variant of thymoma as almost all the patients present with localized low stage disease with rare/no reports of recurrences or distant metastases.Item A rare case of neglected parasitic zoonosis(Wolters Kluwer - Medknow, 2025-03) Noufal, A; Mukundan, A; John, RInfections caused due to zoonotic hookworms are rare and are often under reported. Here we report a case of diarrheal disease caused by Ancylostoma ceylanicum, an important emerging zoonotic hookworm. There is limited knowledge about the epidemiology and disease burden of A. ceylanicum infections in Kerala. A 50?year?old male patient presented with complaints of loose stools for past five weeks. The laboratory investigations revealed a high total WBC count and eosinophil count. Diagnostic colonoscopy showed numerous worms which were identified as A. ceylanicum. Timely diagnosis aided in successful treatment of the patient. Improvement in diagnostic tools and awareness enable accurate and early detection of this neglected but emerging pathogen.Item Disseminated multiloculated peritoneal inclusion cysts: Bubble trouble in belly(Wolters Kluwer - Medknow, 2025-03) Osama, MA; Aggarwal, A; Rao, S; Yadav, A; Verma, RMultiloculated peritoneal inclusion cysts, usually arise from peritoneal mesothelium lining the serous cavity of the abdomen, pelvis and retroperitoneum. These lesions can be incidentally found on imaging or during surgery, and confirmation of the diagnosis is done by radiological imaging, histomorphology and immunohistochemical findings. Although fewer than 200 cases of solitary peritoneal inclusion cysts have been reported, their occurrence in a disseminated fashion has hardly ever been described in literature. Herein, we report a case of multiloculated peritoneal inclusion cysts that involved the whole abdominal and pelvic cavity and were successfully treated with surgery.Item Acute panmylelosis with myelofibrosis - A rare case report with review of literature(Wolters Kluwer - Medknow, 2025-03) Dahiya, S; Kotwal, J; Langer, S; Saraf, A; Prakhar, P; Gupta, D; Gupta, N; Arya, VAcute panmyelosis with myelofibrosis (APMF) corresponds to <1% cases of acute myeloid leukemia, which could be an underestimation due to missed diagnosis. Due to its rapidly fatal course, it warrants a timely and correct diagnosis. We present a case of a 44-year male who came with a short history of fever, generalised weakness, revealed pancytopenia with occasional circulating blast in the peripheral blood smear. Bone marrow aspirate was dry tap,biopsy revealed panmyelosis with myelofibrosis with increased (22%) blasts. Flowcytometric immunophenotyping, cytogenetics and molecular tests were undertaken. Together with clinical details, immunophenotypic profile, cytogenetics and molecular studies, the diagnosis of Acute panmyelosis with myelofibrosis was made and managed accordingly. 32 The WHO 2017 describes APMF as an acute panmyeloid proliferation with increased blasts (?20% in the bone marrow or peripheral blood) and accompanying marrow fibrosis. APMF is rare with poor prognosis thus, must be differentiated especially from Acute megakaryoblastic leukemia to arrive at the correct diagnosis which will help reduce/prevent the early mortality by providing timely chemotherapy followed by upfront hemopoietic stem cell transplantation.Item Papillary glioneuronal tumor: A rare case with recent updates as per 2021 CNS WHO 5th classification(Wolters Kluwer - Medknow, 2025-03) ehrotra, B; Bhargav, M; Kapoor, A; Pandey, S; Brij, S; Gopal, VRThe papillary glioneuronal tumor is a WHO grade 1, rare neuronal?glial tumor and comprises 0.02% of all CNS tumors. Histologically, it is a mixture of glial and neuronal components showing a pseudopapillary pattern with hyalinized vessels. PGNT is considered a low?grade neoplasm, and surgical excision has been curative in most cases. In this paper, we report a new case of papillary glioneuronal tumor in a 44?year?old male having a divergent presentation, to analyze it due to the rarity of its occurrence as per the latest classification.Item CK7+/CK20+/CDX2+ mucinous carcinoma, arising in a mature cystic teratoma of ovary, presenting with disseminated metastasis and pseudomyxoma peritonei(Wolters Kluwer - Medknow, 2025-03) Adhya, AK; Singh, A; Muduly, DK; Sahoo, B.Mucinous carcinomas arising within an ovarian dermoid tumor are rare. Most of the cases reported in the literature show morphological features resembling an appendiceal mucinous neoplasm. They exhibit CK7?/CK20+ immunophenotype similar to carcinomas of the lower gastrointestinal tract. In this report, we have described a case of a well?differentiated mucinous carcinoma arising within a mature cystic teratoma. The mucinous carcinoma showed a spectrum of morphological patterns, including cystadenoma?like areas, proliferative/ borderline areas, villous adenoma?like areas, and areas of invasive carcinoma. In addition, our case showed some unusual findings, namely, diffuse CK7 positivity, associated pseudomyxoma peritonei, and metastasis to lungs. These features were not demonstrated in any of the previously reported cases. Our case shows that the teratomatous mucinous neoplasm of the ovary may show CK7+/CK20+/ CDX2 + immunoprofile making it immunohistochemically indistinguishable from a primary ovarian mucinous neoplasm or a metastatic mucinous carcinoma of the lower gastrointestinal tract.Item Schwannoma-like pleomorphic adenoma: A pathological quandary(Wolters Kluwer - Medknow, 2025-03) Gautam, R; Tomar, R; Rana, D; Khurana, N; Singh, IPleomorphic adenoma usually presents as a painless growing mass in locations of the salivary glands and is notorious for local recurrence if previous surgical resection is incomplete. Schwannoma is a benign peripheral nerve tumor with microscopic features of sheets of spindle?shaped cells with nuclear palisading. However, when a pathologist encounters a salivary gland tumor with microscopic morphological features of biphasic components with areas of schwannoma?like morphology, it is crucial to make a prudent diagnosis by differentiating Schwannoma?like pleomorphic adenoma and its differential diagnosis as they have remarkably different outcome in patients. We herein present a case of Schwannoma?like pleomorphic adenoma and discuss its approach to diagnosis and literature search.