Pseudomyogenic Hemangioendothelioma (Epithelioid Sarcoma-like Haemangioendothelioma) is a rare soft tissue tumor of endothelial origin. It is a distinctive neoplasm having indolent behaviour. A 27-year-old male presented with history of multiple small ulcers over right shoulder region since 2 months. On examination, diffuse indurated plaques were seen over the right shoulder with multiple ulcers. A Provisional diagnosis of non-healing ulcer over right shoulder was offered. Pus culture was positive for coagulase negative Staphyloccus species. The lesion was excised and sent for histopathology. Microscopy showed ulcerated epidermis. Subepithelium showed tumor tissue composed of cells arranged in fascicles, sheets and irregular nodules. Individual tumor cells were oval to spindle shaped cells having brightly eosinophilic cytoplasm and vesicular nucleus with noticeable nucleoli. At places, endothelial cell proliferation and neovascularization was seen. Possibility of epithelioid sarcoma, epithelioid hemangioendothelioma and malignant melanoma was considered. Immunohistochemistry was performed. Neoplastic cells were positive for vimentin, CD31, CK19 and negative for CD34, HMB45 and EMA. A final diagnosis of Epithelioid sarcoma-like Hemangioendothelioma (Pseudomyogenic Hemangioendothelioma) was offered. It is an unusual pathological entity with an unique clinical presentation. Histopathology is challenging. Immunohistochemistry is not only confirmatory, but also mandatory to solve the diagnostic dilemma.

Background: Breast carcinoma is the second most common malignancy in women. Fine needle aspiration cytology of breast is rapid, reliable and safe diagnostic tool to distinguish between neoplastic and non neoplastic lesions. Cytological grading of the smears can provide valuable prognostic information. Aims and Objectives:To study the utility of Masood cytological grading system and to compare it against a new proposed cytological grading system in proliferative epithelial lesions of breast. Methods:The Papanicolaou (PAP) stained Fine Needle Aspiration Cytology (FNAC) smears of proliferative breast lesions were cytologically graded by the Masood cytological grading system and by the newly proposed grading system by two observers independently. Results were correlated with the histopathological diagnosis.Result: In the study period of 2 years, 54 proliferative epithelial lesions were studied of which 47 were proliferative breast disease without atypia and seven proliferative breast diseases with atypia. 42/54 cases in newly proposed system showed concordance with existing Masood grading system. p-value is 0.000 (< 0.005) which is significant. Sensitivity, specificity, positive predictive value and negative predictive value for newly proposed grading system were 88.67%, 100%, 100% and 85.71% respectively. Conclusion:A simple slide based scoring system of epithelial lesions of breast is a useful tool in the prognostication and prediction of behavior of proliferative epithelial lesions.