SRI RAMACHANDRA HOSPITAL

Sri Ramachandra Medical College & Research Institute

INVESTIGATION REPORT
HISTOPATHOLOGY

Patient Name & Address

Referred to
MR.SUBBARAO A V
HISTOPATHOLOGIST
NO:1-23, B.KOTTURU
PITTAPURAM MANDALAM, EAST GODAVARI Department
,ANDHRA PRADESH,533431 HISTOPATHOLOGY
INDIA, Ph No:-
PatientID : 0021663497 Age : 58 YRS Sex : MALE Result No : 0000145081 AccessNo : H-786/2022
Collected : Received : 23/11/2022 16:10:07 Resulted : 29/12/2022
16:43:42.6430000
Final Impression

The IHC pattern favors the diagnosis of a high-grade synovial sarcoma with mucinous features. See comment

Clinical Diagnosis :
Left lnguinal lymphadenopathy

Specimen Site :
Swelling from left inguinal region

Gross :
Received single grey brown soft tissue mass (M) 8x5x5cm wt 43gm. External surface - grey brown, lobular. focal grey black
area noted with attached soft tissue. Cut surface -shows a solid lesion (M) 7x5x4cm, grey brown with focal friable and
papillary areas noted, ? vein (M) 5.8x1.8x1.2cm in the superior surface and anterior surface. Lumen - thrombosed. Tumour is
seen abutting the vein.
Anterior, posterior , inferior, medial margin - all margin involved,
Distance of lesion from lateral margin -1.6cm clearance.
Distance of lesion from inferior margin -0.2cm clearance.
Partially embedded
A1- tumour with medial margin
A2- tumour with lateral margin
A3-tumour with superior margin
A4- tumour with inferior margin
A5- posterior margin
A6- anterior surface with tumour and vein
A7- vein from superior surface
A8- A11- random tumour bits

Grossed by Dr.Banu
Microscopy :

Dr.V.Pavithra
Dr.Uma Sekar MD,DCP Professor
Director-Central Laboratory Services Med.Reg.No:
Released by

All investigations have their limitations which are imposed by the limits of sensitivity and specificity of individual assay procedures as well as the quality of the specimen received by laboratory.Isolated laboratory investigations never
confirm the final diagnosis of the disease.They only help in arriving at a diagnosis in conjunction with clinical presentation and other related investigations.The contents of this report may be used for statistical analysis and reseach
purpose in this insititute.
PARTIAL REPRODUCTION OF THIS REPORT IS NOT PERMITTED
Electronically signed & released.No Signature required

No.1,Ramachandra Nagar,Porur,Chennai-600 116 Ph : +91 044 2476 8027,31 - 33 Ext.227 , 233

Page 1 of 3 Print Date : 14/03/2023

 SRI RAMACHANDRA HOSPITAL
Sri Ramachandra Medical College & Research Institute
INVESTIGATION REPORT
HISTOPATHOLOGY

Patient Name & Address

Referred to
MR.SUBBARAO A V
HISTOPATHOLOGIST
NO:1-23, B.KOTTURU
PITTAPURAM MANDALAM, EAST GODAVARI Department
,ANDHRA PRADESH,533431 HISTOPATHOLOGY
INDIA, Ph No:-
PatientID : 0021663497 Age : 58 YRS Sex : MALE Result No : 0000145081 AccessNo : H-786/2022
Collected : Resulted : 29/12/2022
Received : 23/11/2022 16:10:07
16:43:42.6430000
a)Section sent as lymph node shows nests and sheets of malignant cells admixed with extensive extracellular mucin and
myxoid areas. Individual cells have ill-defined cell border,moderate eosinophilic cytoplasm,vesicular nuclei showing mild to
moderate pleomorphism with increased nuclear cytoplasmic ratio. Some of them have a prominent nucleoli.
b)Areas of necrosis and hemorrhage are also noted.

Previous Impression : Metastatic high grade poorly differentiated malignancy..Advised clinical correlation and
immunohistochemistry (Vimentin,CDX2, NKX3.1, S100, CD45, CK20, HMB45, CK7.
ADDENDUM(3/12/2022-DR.LDJ)
IHC-tumor cells positive for vimentin. Negative for CDX2, NKX3.1, S100, CD45, CK20, HMB45, CK7.

ADDENDUM(21/12/2022): By IHC the tumor cells are negative for synaptophysin, chromogranin, ERG and CD34

Previous Impression : Metastatic deposit with mucinous features .Advised IHC (PanCK,EMA,CK19 &TLE1) for further
categorisation.

ADDENDUM(28/12/2022):
By IHC the tumor cells show :
Immunopositivity for TLE-1, focal and patchy positivity for PanCytokeratin and EMA.
Immunonegativity for CK19

COMMENT: In view of the immunohistochemistry positivity for vimentin and TLE-1, with focal and patchy positivity for
PanCytokeratin and EMA, the possibility of a high grade sarcoma may be considered. However further immunohistochemistry
(Bcl-2, SOX-10 and Ki-67 labelling index) and molecular workup is strongly recommended.

Previous Impression :In view of the IHC the possibility of a high grade sarcoma has to be considered . See comment.

ADDENDUM(29/12/222): Amended report :

By IHC the tumor cells are diffusely and strongly positive for BCL-2,
Negative for SOX-10.
Ki 67 labelling index-70%.

COMMENT: The morphology of the tumor is not typical of a sarcoma due to presence of the mucinous and myxoid features
with unusual morphology, molecular workup is strongly recommended.

(REFERENCE:
Weinreb I, Perez-Ordoñez B, Guha A, Kiehl TR. Mucinous, gland predominant synovial sarcoma of a large peripheral nerve: a
rare case closely mimicking metastatic mucinous carcinoma. J Clin Pathol. 2008 May;61(5):672-6. doi:
10.1136/jcp.2007.053124. PMID: 18441160.)
Reporting Pathologist :
Dr Pavithra/ Dr G. Vasugi/ Dr. Leena D/ Dr Sandhya Sundaram

Dr.V.Pavithra
Dr.Uma Sekar MD,DCP Professor
Director-Central Laboratory Services Med.Reg.No:
Released by

All investigations have their limitations which are imposed by the limits of sensitivity and specificity of individual assay procedures as well as the quality of the specimen received by laboratory.Isolated laboratory investigations never
confirm the final diagnosis of the disease.They only help in arriving at a diagnosis in conjunction with clinical presentation and other related investigations.The contents of this report may be used for statistical analysis and reseach
purpose in this insititute.
PARTIAL REPRODUCTION OF THIS REPORT IS NOT PERMITTED
Electronically signed & released.No Signature required

No.1,Ramachandra Nagar,Porur,Chennai-600 116 Ph : +91 044 2476 8027,31 - 33 Ext.227 , 233

Page 2 of 3 Print Date : 14/03/2023

 SRI RAMACHANDRA HOSPITAL
Sri Ramachandra Medical College & Research Institute
INVESTIGATION REPORT
HISTOPATHOLOGY

Patient Name & Address

Referred to
MR.SUBBARAO A V
HISTOPATHOLOGIST
NO:1-23, B.KOTTURU
PITTAPURAM MANDALAM, EAST GODAVARI Department
,ANDHRA PRADESH,533431 HISTOPATHOLOGY
INDIA, Ph No:-
PatientID : 0021663497 Age : 58 YRS Sex : MALE Result No : 0000145081 AccessNo : H-786/2022
Collected : Received : 23/11/2022 16:10:07 Resulted : 29/12/2022
16:43:42.6430000

** End Of Report **

Dr.V.Pavithra
Dr.Uma Sekar MD,DCP Professor
Director-Central Laboratory Services Med.Reg.No:
Released by

All investigations have their limitations which are imposed by the limits of sensitivity and specificity of individual assay procedures as well as the quality of the specimen received by laboratory.Isolated laboratory investigations never
confirm the final diagnosis of the disease.They only help in arriving at a diagnosis in conjunction with clinical presentation and other related investigations.The contents of this report may be used for statistical analysis and reseach
purpose in this insititute.
PARTIAL REPRODUCTION OF THIS REPORT IS NOT PERMITTED
Electronically signed & released.No Signature required

No.1,Ramachandra Nagar,Porur,Chennai-600 116 Ph : +91 044 2476 8027,31 - 33 Ext.227 , 233

Page 3 of 3 Print Date : 14/03/2023