1.Emphysematous pyelonephritis in a diabetic leading to renaldestruction: pathological aspects of a rare case
Archana Shetty ; Vijaya C ; Geethamani V ; Savitha Anil Kumar
The Malaysian Journal of Pathology 2013;35(1):103-106
Emphysematous pyelonephritis is a severe, potentially fatal necrotizing pyelonephritis with a
variable clinical presentation, ranging from mild abdominal pain to septic shock. The majority
of cases occur in diabetics with poor glycemic control, while a small percentage may be due to
urinary tract obstruction. We present a case of a 57 year old male patient, diabetic on treatment,
presenting with left fl ank pain and poor stream of urine since one week. Laboratory tests revealed
that the patient had electrolyte imbalance, ketoacidosis and high blood sugar. Urine culture was
positive for Escherichia coli with a signifi cant colony count. Radiological examination gave a
diagnosis of Left Type 1 Emphysematous Pyelonephritis. Inspite of giving vigorous resuscitation
and antibiotics with nephrostomy, the patient had to undergo nephrectomy due to extensive renal
parenchymal destruction.
The nephrectomy specimen was studied in detail to know the histopathological fi ndings in a case
of diabetic patient with emphysematous pyelonephritis. We present this case not only because of
it being a rare complication of diabetes, but also to focus on the histopathological fi ndings of the
same, documentation of which is limited in literature.
2.Malignant myoepithelioma of the breast: case report with review of literature
SUGUNA BV ; GEETHAMANI V ; NIVEDITHA SR ; MONIKA Lamba Saini
The Malaysian Journal of Pathology 2011;33(2):125-128
Myoepithelial lesions of the breast are extremely rare and can present with a diverse morphology.
We report a case of malignant myoepithelioma characterized by proliferation of atypical oval to
polygonal cells expressing typical myoepithelial markers. A 45-year-old lady presented with a mass
in the left breast. Fine needle aspiration yielded a cellular smear with large papillae-like clusters
of monomorphic cells with naked nuclei in the background. A diagnosis of sub-areolar sclerosing
duct hyperplasia was made on cytology and the patient underwent excision. The surgical specimen
showed a grey-white 5x3 cm mass on cut surface. Histopathology revealed mitotically active (5-6
per 10hpf) oval to polygonal cells tumor cells with clear to eosinophilic cytoplasm arranged in the
form of nodules separated by dense sclerotic stroma mimicking clear cell or adenoid-cystic carcinoma.
A diagnosis of malignant myoepithelioma was made as the cells were CK14 and SMA positive, and
negative for ER and PR on immunohistochemistry. We discuss the unusual morphological features of
malignant myoepithelioma, cytological fi ndings and the important differential diagnoses of malignant
myoepthelial lesions. A high degree of suspicion with a keen eye for morphological details coupled
with relevant immunohistochemistry will aid in arriving at the diagnosis.