Amancharla Yadagiri Lakshmi

Multiple primary cancers: An enigma.

Background: Incidence of multiple primary cancers though uncommon, is being frequently reported now-a-days owing to better diagnostic techniques, the prolonged life span and the increased incidence of long-term survival of cancer patients. Materials and Methods: This is a retrospective study. Cases of multiple malignancies diagnosed histopathologically were retrieved from the archives of department of surgical oncology. Clinical data were obtained from the medical records. They were categorized as synchronous malignancies if the interval between them was less or equal to 6 months and metachronous, if the interval was more than 6 months. Results: A total of 13 cases were encountered in the 5 year study period. Out of them two were in the metachronous category and the rest were synchronous as the 2nd malignancy was detected mostly during clinical evaluation of the patients for the primary malignancy. There was female predominance with age range being 43-68 years. Majority of the cases were in the 7th decade. The most common organ involved was breast, followed by cervix. Apart from bilateral breast malignancies, there were combinations like breast with uterine endometrial carcinoma, cervical carcinoma and even papillary thyroid carcinoma. Conclusion: Detection of multiple primary malignancies is becoming increasingly common in day-to-day practice. Greater awareness of this is required among both cancer patients and their treating clinicians.

Magnetic resonance angiography vs. angiography in tetralogy of Fallot.

Aim: To determine whether gadolinium-enhanced three-dimensional magnetic resonance angiography can provide a noninvasive alternative to diagnostic catheterization for evaluation of pulmonary artery anatomy in tetralogy of Fallot. Patients and methods: Thirty-five consecutive patients with tetralogy of Fallot, who attended the cardiology outpatient department between January 2008 and December 2009, were included in the study. There were 21 males and 14 females, with a mean age of 9 ± 4.15 years (range, 3–21 years). Thirty-two patients had tetralogy of Fallot with varying severities of valvular and infundibular stenosis. Three patients had tetralogy of Fallot with pulmonary atresia. All patients underwent both cardiac catheterization with X-ray angiography and 3-dimensional magnetic resonance angiography within one month. Results: Measurements of right and left pulmonary arteries and aortopulmonary collaterals were equal by both methods. There was a good correlation between magnetic resonance angiography and catheterization measurements of branch pulmonary arteries. Conclusion: Gadolinium-enhanced three-dimensional magnetic resonance angiography can be used as a reliable noninvasive alternative to X-ray cineangiography for delineation of pulmonary arterial anatomy in sick infants and young children, obviating the need for catheterization.

Solid and cystic papillary neoplasm of pancreas: A clinic-pathological and immunohistochemical study: A tertiary care center experience.

Background: Solid pseudopapillary tumor of the pancreas (SPT) is a rare tumor of low malignant potential, mostly described in young women. Materials and Methods: In this retrospective study from January 2000 - December 2010, there were 50 pancreatic tumors. In this period, four SPTs were encountered, which were analyzed with respect to clinical, imaging, histopathological, and immunohistochemical findings. Results: There was a female preponderance with mean age of 22.2 years. Two of the tumors were located in head of the pancreas and two in the body and tail region. On imaging, majority were large cystic tumors. Histopathologically, they exhibited extensive necrosis and presence of pseudo papillae in viable areas. Immunohistochemically, they were positive for alpha-1-anti-trypsin, alpha-1-anti-chymotrypsin, vimentin, CD10, and CD99. Progesterone receptor and p53 exhibited mild positivity in all of the four cases, whereas neuron specific enolase (NSE), synaptophysin, and chromogranin showed focal positivity in one case. Conclusion: Despite its non-specific clinical, imaging, and even immunohistochemical features, characteristic gross and microscopic findings provide reliable diagnosis of SPTs.

Primary Ovarian Leiomyoma: An Uncommon Entity ‑ Case Report and a Brief Review of Literature

Among all benign primary ovarian smooth muscle tumors, ovarian leiomyoma, is uncommon, accounting for 0.5-1% of all tumors. Most of these tumors are unilateral, small in size, and generally occur in premenopausal women. This paper presents a case report of primary ovarian leiomyoma, which is a rare entity, in a postmenopausal female with complaints of abdominal pain. The left ovarian mass was histopathologically and immunohistochemically diagnosed as ovarian leiomyoma. Unlike smooth muscle tumors of uterine origin, there are no definite histological criteria to categorize smooth muscle tumors of ovary. This is an additional case of ovarian leiomyoma with brief review of literature, especially highlighting differential diagnosis of ovarian spindle cell lesions.

Malposition of hemodialysis catheter in left superior intercostal vein.

Malposition of hemodialysis catheter needs to be identified promptly. Straight descent of left side internal jugular catheter mandates a thorough evaluation than unnecessary apprehensions. We report an unusual case of straight descent of hemodialysis catheter into superior intercostal vein.

Intracranial meningioma, mimicking brain metastasis on 18F sodium fluoride bone scan in a case of carcinoma cervix

Bone scintigraphy (BS) is a well--established commonly used imaging modality for staging and follow--up evaluation of cancer patients. Occasionally, BS may show asymptomatic unusual extraosseous lesions in the body which may or may not be related to primary disease. We here present an interesting case of carcinoma cervix in whom 18F sodium fluoride positron emission tomography-computerized tomography (PET-CT) bone scan detected an intracranial lesion. Initially, this lesion was suspected as brain metastasis; however, later on, combined PET--CT images and contrast-enhanced CT confirmed this lesion as calcified falcine meningioma in the right posterior parietal region.

Metastasis in central nervous system: Clinicopathological study with review of literature in a tertiary care center in South India

Background: Secondary central nervous system (CNS) tumors are common in Western countries, but in Indian literature, scant data are available. With the advent of newer imaging techniques, the confirmatory histopathological diagnosis has become comparatively easier. Hereby, we have analyzed our data from a single tertiary care center in south India. Materials and Methods: In this retrospective study from January 2000 to December 2010, histopathologically diagnosed secondary CNS tumors were reviewed along with clinical, imaging, and relevant immunohistochemical findings. Meningeal, lymphoproliferative, and myeloproliferative tumors and autopsy data were not included in the study group. Results: There were 40 secondary CNS tumors. Male to female ratio was 2.3:1. Age range was wide (28-75 years). Majority of cases were seen in the fourth and fifth decade. Imaging-wise, (computed tomography and magnetic resonance imaging) majority were single lesions (n = 34, 85%). Most commonly, these single lesions were present in the cerebral hemisphere (n = 20, 50%) followed by cerebellum (n = 10, 25%). Adenocarcinoma accounted for maximum number of cases (n = 25, 62.5%) with lungs being the most common primary. Conclusion: We have noted 25% metastatic adenocarcinomas in cerebellar location, which is higher when compared with available world literature. However, we also encountered a good number of cases (30%) due to unknown primary. Though histopathological examination with use of immunohistochemical markers can reliably distinguish primary from secondary CNS tumors in addition to available clinical and imaging data, particularly in developing countries, still a better work-up with an array of immunohistochemical markers and newer imaging modalities is desirable.

Utility of bone scintigraphy in diagnosis of post- traumatic osteitis pubis

Minor musculoskeletal injuries usually heal within few weeks with conservative treatment, but in pelvic injuries, symptoms may persist for long duration and patient need medical attention to get relief from disturbing pain symptoms. We present a case of post-trauma osteitis pubis in a 58-year-old female, who reported with lower abdominal and left side hip joint pain since 2 months, after an episode of trivial trauma to her pelvis. Technetium-99m methylene diphosphonate bone scintigraphy was performed, which confirmed the site of injury in symphysis pubis and left hip joint, by increased radiotracer localization at both of these symptomatic sites.

Hepatic metastasis arising from diverse primary pathologies diagnosed on 99mTc-Methylene diphosphonate bone scan

We are presenting two cases that illustrate nonosseous localization of 99mTc-Methylene diphosphonate (MDP) in hepatic metastases arising from varied primary pathology and review of the literature. This series emphasizes the evidence of MDP localization in hepatic metastases arising from adenocarcinoma of rectum and infiltrating duct cell carcinoma of the breast.

Multifocal skeletal tuberculosis

A 54-year-old diabetic, hypertensive smoker (60 pack years) with chronic kidney disease Stage V and on dialysis, presented with hoarseness and weight loss. His hemoglobin was 9 g/dL, erythrocyte sedimentation rate (ESR) 60 mm at the first hour, blood urea 7 mmol/L and serum creatinine 70 µmol/L. Computed tomography (CT) of the chest showed a mass in the hilum of the left lung and enlarged mediastinal and cervical lymph nodes. Meanwhile, he developed a high-grade fever, low back pain and painful fixed flexion of both hip joints. The X-rays of both hip joints and the lumbosacral spine were normal. In clinical assessment, bronchogenic carcinoma with skeletal secondaries was suspected. The results of the 18-F Fluoro deoxy glucose (FDG) Positron Emission Tomography (PET)-CT scan showed increased tracer uptake in the mediastinal and cervical lymph nodes, left lung hilum, dorsal vertebrae, bilateral iliacus muscles, bilateral hip joints and acetabulum of the right femur (Figure 1). Fine-needle aspiration of the left iliacus muscle revealed pus with plenty of polymorphs. Tuberculosis (TB) polymerase chain reaction evaluation of the pus was positive. He was initiated on antituberculosis treatment. Mycobacterium TB (MTB) was grown after 6 weeks. The diagnosis was multifocal skeletal TB (MFSTB). Fig. 1. 18-F FDG PET-CT maximum intensity projection (MIP) image, showing the increased FDG localization in multiple musculoskeletal lesions and lymph nodes. MFSTB is an entity where osteoarticular lesions occur simultaneously at two or more locations [1]. MFSTB constitutes less than 5% of skeletal TB. MFSTB is more common in those who are immunocompromised, or on hemodialysis [1]. The radiological evaluation reveals multiple destructive lesions in the bone, which may be confused with secondary or primary osseous lesions. Hence, the diagnosis of MFSTB is ultimately confirmed on histopathology or on microbiological studies. In our patient, lymph nodes and multiple skeletal sites were involved. Microbiological evaluation confirmed MTB. In conclusion, in the presence of multiple skeletal lesions in patients on dialysis, MFSTB should be considered in the differential diagnosis. MFSTB is a great mimicker of malignancy and hence requires early confirmation.