Clinical tissue processing such as formalin fixing, paraffin-embedding and histological staining alters significantly the optical properties of the tissue. We document the alterations in the optical properties of prostate cancer tissue specimens in the 500nm to 700nm spectral range caused by histological processing with quantitative differential interference contrast (qDIC) microscopy. A simple model to explain these alterations is presented at the end.

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Adrenocortical carcinoma (ACC) is a malignant tumour arising from the adrenal cortex, while pheochromocytoma is a catecholamine secreting tumour of the adrenal medulla or extra adrenal sites. Both conditions are very rare, with incidence of approximately 1–2 cases per million adults annually. Most adrenocortical tumours are functioning. ACC can be associated with clinical Cushing syndrome and virilisation due to excessive production of cortisol and androgens, respectively. However, it is rare for ACC to present clinically as pheochromocytoma. We report a case of a 28-year-old lady who presented with paroxysmal hypertension and palpitations associated with raised urinary vanillyl mandelic acid. On examination, there was postural hypotension and ballotable mass in right lumbar region with no obvious features suggestive of Cushing syndrome or virilisation. A huge right suprarenal mass with areas of necrosis and calcification was noted on the abdomen CT. A right adrenalectomy was done. The histology was consistent with ACC. There are reported cases of ACC presenting with clinical features of pheochromocytoma but limited in number, accounting for barely a dozen cases in the literature. This pseudopheochromocytoma may be due to the presence of neuroendocrine features in ACC.

Adrenal cortical carcinoma (ACC) is a rare malignant tumour which arises from the adrenal cortex with diverse clinical manifestations due to excessive hormone production, with Cushing’s syndrome and virilisation being the most common features. The diagnosis of ACC relies on clinical, hormonal, and imaging features before surgery and pathological examination after tumour removal. Pathological assessment of Weiss score and the Ki-67 labelling index play an important role in diagnosis and prognosis. The tumour, lymph node, and metastasis (TNM) classification, established by the European Network for the Study of Adrenal Tumors (ENSAT) is used for staging. Currently, complete surgical resection is the only treatment option for ACC that has a curative intent, with no reported difference in overall recurrence or mortality between open and laparoscopic adrenalectomy. Mitotane is used as an adjuvant therapy after surgery for high-risk patients and as primary treatment for unresectable and advanced cases; however, it has a narrow therapeutic index and regular blood monitoring is essential. The role of chemotherapy and radiotherapy in ACC is unclear with limited studies and varying results. To date, trials which have been conducted for novel agents revealed disappointing results. Currently, trials are underway for agents targeting steroidogenic factor-1, mechanistic target of rapamycin (mTOR), and Wnt signalling pathways, as well as inhibitors of acetyl-coA cholesterol acetyltransferase 1. Unfortunately, ACC has an aggressive natural course with high recurrence rate, and a reported 10-year survival of 7% after treatment.

Myasthenia gravis (MG) is an autoantibody-mediated disorder affecting the neuromuscular junction causing characteristic fatigable muscle weakness. Though it can be associated with tumours of the thymus as well as thyroid disorders, it is rare for both to coexist. The exact prevalence of thyroid carcinoma in MG with thymoma is not known but only about a dozen cases have been reported in the literature. We report a case of a 38-year-old Myanmar lady who presented with weakness and breathlessness due to MG with neck swelling. On examination, she had fatigable proximal muscle weakness and thyroid enlargement with no obvious features of hyperthyroidism. Mediastinal widening and an enlarged thyroid gland were noted on her chest X-ray and chest CT. A subtotal thyroidectomy and thymectomy were done. The histology showed follicular carcinoma of the thyroid and benign thymoma. The majority of the reported cases of thyroid carcinoma in association with MG were papillary carcinoma. Follicular carcinoma thyroid associated with MG has not yet been reported in the literature.