Germ cell tumor is the most common malignancy in men aged 15-35 years. About five percent of the malignant germ cell tumors are extragonadal in origin. However metastatic deposit of seminoma in retroperitoneal lymph node without presence of any tumor in the testes is uncommon. We present a case of metastatic retroperitoneal seminoma as the initial presentation of a burned out testicular primary. The patient presented with pain in abdomen and back. Ultrasonography of the testis showed a lesion, which after high inguinal ochidectomy was reported as fibrosis only, without any tumor, i.e. burned out phenomenon. A laparotomy biopsy of the retroperitoneal lymph node mass was taken and reported as metastatic seminoma after immunohistochemistry. After 14 months of chemotherapy there is a residual lymph node of less than 3cm, serum tumor markers are normal and the patient is under observation.Keywords Seminoma . Burned out phenomenon . Testis . Extragonadal germ cell tumor Case ReportA 33 year old Indian male presented to our Institute with pain in abdomen and back intermittently, for 3 months duration. Patient is a tobacco chewer and hypothyroid under treatment. There was no significant history, physical examination was normal.Ultrasonography (USG) of abdomen revealed a heterogeneous mass in the retroperitoneum. Contrast enhanced computed tomography (CECT) of abdomen showed a rim enhancing lesion 6.1×5.0 cm at aortic bifurcation [ Fig. 1a]. Trucut biopsy was done and histopathological examination (HPE) reported as poorly differentiated carcinoma or NonHodgkin's lymphoma. Immunohistochemistry (IHC) showed CD117 positivity in the tumor cells, suggestive of seminoma. The tumor cells were negative for pancytokeratin, CD30 and CD45.To find out the primary, USG of bilateral testes was done, which showed a heterogenous lesion of 1.5×1.2 cm in the left testicle [ Fig. 1b]. Testicular tumor serum markers human chorionic gonadotropin (hCG), alphafetoprotein (AFP) and lactate dehydrogenase (LDH) were normal.Left high inguinal orchidectomy was done. On gross, a whitish scar like lesion was noted [Fig. 1c]; microscopically no tumor was found; only fibrosis was seen. Re-grossing and re-examination of the specimen was reported as same.Laparotomy and biopsy from the retroperitoneal lymph nodal mass was done. HPE showed neoplastic cells in sheets and nests with intervening thin fibrous septae and scattered lymphocytes. The cells had vesicular nuclei, prominent nucleoli and pale cytoplasm [ Fig. 1d], suggestive of (1) metastatic/ primary seminoma, (2) metastatic/primary poorly differentiated carcinoma. No definite lymph nodal architecture could be

We report the case of a 27-year-old female with intraparenchymal leiomyoma of the breast. This case is interesting not only because intraparenchymal leiomyoma of the breast is a rare benign non-epithelial tumor, but also because it is never found in women at such an early age. We explain all the aspects of this case in this report with its radiologic, histopathologic and immunohistochemical findings.

A primitive neuroectodermal tumor (PNET) in the breast developed in a 36-year-old Indian woman who initially underwent lumpectomy and was diagnosed as the malignant phyllodes tumor of the right breast. Within 2 months it recurred, clinicoradiologically appearing like organized collection. Incision and drainage along with biopsy was done. The tissue diagnosis was reported as PNET. The histopathology report showed the tumor cells as malignant round cells, immunohistochemically positive for CD99, vimentin and neuron-specific enolase (NSE) (patchy) and negative for CD45, cytokeratin, S100, and desmin. Extended simple mastectomy was carried out. She came after another interval with recurrence. Chemotherapy as well as radiotherapy was given. After 18 months of surgery, the patient is having persistent stable disease without distant metastasis. PNET in adults is rare and has been reported in the chest wall (Askin tumor) and other visceral sites. To our knowledge, only a few cases have been reported of a primary PNET of the breast.Keywords Primitive neuroectodermal tumor . Malignant phyllodes tumor . Breast Case ReportA 36-year-old married Indian woman was referred to Cancer Centre Welfare Home and Research Institute after lumpectomy as a malignant phyllodes tumor in the right breast.On examination of the right breast, no mass was felt except a scar mark of previous lumpectomy. Mammogram and ultrasonography of both breasts did not reveal any positive finding. USG abdomen and chest X-ray reports were normal. The review of lumpectomy histopathology slides in our institute reported it as same (i.e., malignant phyllodes tumor). Wide excision was done with a good margin; after nearly 1 month of the first surgery, histopathological examination (HPE) reported no residual tumor.After 2 months, the patient presented again with the lump measuring 8 cm×5 cm and pain in the right breast. Clinical impression was serous collection with some solid component. USG breast showed multiple areas of heterogenous echotexture with multiple septae, impressing organized collection. Fine-needle aspiration cytology (FNAC) was reported as duct carcinoma but it did not corroborate clinically. Incision and drainage was done. Blood-mixed fluid with a few friable tissues came out. The histopathology report showed sheets of neoplastic round cells with high nucleocytoplasmic ratio and coarse chromatin. Brisk mitoses were noted. A few pseudorosettes and rosettes were seen. With immunohistochemistry (IHC), the report came as PNET (vimentin positive, CD99 strongly positive, NSE patchy positivity; CD45, cytokeratin, S100, and desmin negative).Right extended simple mastectomy with en-bloc resection of pectoralis major muscle was done (Fig. 1a). On gross examination of specimen, a grayish white fleshy soft mass with partly necrotic area was found. Final diagnosis was given as PNET of the right breast based on IHC findings (Fig. 2). Level I lymph nodes were reactive. The pectoralis major muscle was involved, but all margins were free. The

A unique case of unilateral ovarian luteinized thecoma with sclerosing peritonitis is reported because the association between these two conditions is extremely rare. Etiology is not clearly known. A 50-year-old post-menopausal woman presented with pain abdomen and huge swelling. Pelvic contrast-enhanced computed tomography (CECT) revealed a heterogenous enhancing mass arising possibly from ovary and adherent to uterus, bowl loops, and omentum. A spindle cell neoplasm without definite features of malignancy was reported in computed tomography (CT)-guided fine-needle aspiration cytology (FNAC). Ascitic fluid was negative for malignancy. Her serum carcinoembryonic antigen (CEA) (1.1ng/ml) and CA125 (27.6μ/ml) level was within normal limits. Total abdominal hysterectomy with bilateral supracolic omentectomy, resection of part of colon, and supracolic omentectomy was done. Histopathological diagnosis was luteinized thecoma with sclerosing peritonitis. Tumor cells were immunoreactive to smooth muscle antigen (SMA) and CD 99 and non- reactive to ER, PR, Calretinine, and Cytokeratin. Patient developed post-operative sepsis and enterocutaneous fistula, which was managed conservatively and was kept in follow-up. According to current concept, in spite of its large size, wide-spread involvement, mitotic activity, and complications due to peritoneal involvement, behavior of this rare clinical entity is benign.