Parveen Rana

An unusual case of sciatic neuropraxia due to melorheostosis

Melorrheostosis is a rare osteosclerotic bone dysplasia of obscure etiology. The typical radiographic features are flowing candle wax, sub-periosteal bone and streaky endosteal bone formation in diaphyseal and epiphyseal area with sclerotomal pattern mainly involving appendicular skeleton. It is rarely associated with nerve palsies. The authors report a case of melorrheostotic mass causing sciatic neuropraxia and to the best of their knowledge it is the first case reported in the English language literature.

Lipoleiomyoma of Uterus: Uncommon Incidental Finding

Fatty tumours of the uterus are exceedingly rare. Lipoleiomyoma of the uterus is a rare benign uterine tumour thought to be a variation of leiomyoma. The presence of fatty tissue in the myometrium is anomalous, interpreted as lipomatous degeneration, smooth muscle metaplasia or as a benign tumour called as lipoleiomyoma. Imaging can play an important role in determining the intrauterine location and fatty nature of lipoleiomyomas but most of these are detected by chance pathological findings postoperatively. We report a case of lipoleiomyoma in anterior uterine wall in 66 years old postmenopausal female, who presented with postmenopausal bleeding.

A rare case of Endometriosis in vaginal hysterectomy scar

Presented hereunder is probably the first reported case of endometriosis at the vaginal apex following vaginal hysterectomy. No other similar case could be traced in the review of the literature.

Effect of intravenous zoledronic acid on histopathology and recurrence after extended curettage in giant cell tumors of bone: A comparative prospective study

Background: Giant cell tumor (GCT) of the bone is known for its locally aggressive behavior and tendency to recur. It is an admixture of rounded or spindle-shaped mononuclear neoplastic stromal cells and multinucleated osteoclast-like giant cells with their proportionate dispersion among the former. Zoledronic acid (a bisphosphonate) is being used in various cancers such as myelomas and metastasis, for osteoporosis with an aim to reduce the resorption of bone, and as an adjuvant treatment for the management of GCT of bone for reduction of local recurrence. We have carried out a prospective comparative study to assess the effect of intravenous infusion of zoledronic acid on histopathology and recurrence of GCT of bone. Materials and Methods: The study was carried out in the biopsy proven GCTs in 37 patients; 15 males and 22 females, in the age range from 17 to 55 years. They were treated with extended curettage. Of these 37 patients, 18 were given three doses of 4 mg zoledronic acid infusion at 3-week intervals and extended curettage was performed 2 weeks after the last infusion whereas the other 19 were treated with extended curettage without zoledronic infusion. The post infusion histopathology of the curetted material was compared with the histopathology of initial biopsy. All the patients were evaluated at 3-month intervals for the first 2 years and then six monthly thereafter, for local recurrence and functional outcome of limb using the Musculoskeletal Tumor Society (MSTS) score. Results: In postzoledronic infusion cases, the histopathology of samples showed abnormal stromal cells secreting matrix leading to fibrosis and calcification. The type of fibrosis and calcification was different from pathological calcification and fibrosis what is usually observed. There was a good marginalization and solidification of tumors which made surgical curettage easier in six cases in the study group. There was noticeable reduction in the number of giant cells and alteration in morphology of stromal cells to the fibroblastic-fibrocytic series type in comparison to preinfusion histopathology. Recurrence occurred in one case out of 18 patients in infusion group whereas in four cases among 19 patients in control group. The functional results were assessed, and the overall average MSTS score was 27.50 (range 24–30) and 27.00 (range 23.50–30) in the study and control groups, respectively. Conclusions: We observed that bisphosphonates reduce osteoclast activity and affects stromal cells in GCT, resulting in the reduction of their numbers and noticeable apoptosis. This results in better marginalization of the lesions and reduced recurrence. Extended curettage of friable GCT became easier and adequate which otherwise might not have been possible.

Evaluation profile of thyroid nodule by fnac in the rural population of khanpur kalan, sonepat, haryana.

BACKGROUND Thyroid disease is most common endocrine disorder and is different from other endocrine diseases because of its visible swelling and ease of diagnosis. If left untreated, thyroid disease makes a person more prone for heart disease, infertility and osteoporosis. In India, significant burden of thyroid diseases exist with an estimation of around 42 million cases. The thyroid status and autoimmune status of adult Indian population in the post iodinization phase is largely unknown. AIM The main objective of this study was to generate valuable epidemiological data regarding the prevalence of thyroid disorders in rural population of Khanpur Kalan, Sonepat in the post-iodinisation era in India. To assess whether thyroid autoimmunity or goitrogens along with environmental factors play role in the development of thyroid.This paper is being presented in view that no such study has been carried out in the rural population of this region in Haryana. MATERIALS AND METHODS The present study was conducted in Department of Pathology, Bhagat Phool Singh Medical College for Women, Khanpur Kalan, Sonepat between August 2011 to July 2013. It included retrospective analysis of cytomorphology of fine needle aspiration cytology material of 206 patients presenting with thyroid nodule in the Department of Pathology. RESULTS The commonest age group affected was 31-40 yrs. The female patients (93.4%) outnumbered the male patients (6.6%).The cytomorphological analysis of 206 patients revealed 190 cases (92.2%) of neoplastic lesions, 10 cases (4.8%) were neoplastic and 6 cases (2.9%) had indeterminate cytomorphology. Maximum number (65.5%) of patients was suffering with goiter followed by lymphocytic thyroiditis (26.2%). Amongst the malignant cases three cases were of papillary carcinoma and one case of medullary carcinoma. Two out of the six cases of follicular neoplasm proved to be follicular adenoma on histopathology. Four patients with high T3 levels were under treatment with neomercazole. They showed change in cytomorphology from hyperplasia to colloid goiter. Only one case of acute suppurative thyroiditis was reported which shows rarity of its type. CONCLUSION The increased prevalence of goiter in this post iodinisation era can be attributed to goitrogens, autoimmune thyroid disease and micronutrient deficiency of iron and selenium. Higher prevalence of autoimmune thyroiditis in females is linked with both genetic and environmental factors such as infection, stress.

Metaplastic Carcinoma of Breast with an Intracanalicular Fibrodenoma-A Rare Case Report

Metaplastic Carcinoma of Breast with an Intracanalicular Fibrodenoma-A Rare Case Report Fibroadenomas are benign tumors that are labeled under the group proliferative lesions without atypia. Carcinoma arising de novo in fibroadenoma is rare. Presence of carcinoma within fibroadenoma is usually a secondary involvement from adjacent carcinoma. Incidence of a carcinoma evolving within a fibroadenoma is reported to be 0.002-0.0125%. Complex fibroadenoma and proliferative disease adjacent to the fibroadenoma are associated with a slight increase in the risk of breast cancer. But there are no clinical or mammographic features that have value in the diagnosis of carcinoma within a fibroadenoma until breach of false capsule. Metaplastic breast carcinoma arising in a fibroadenoma is a rare incidental finding. The etiology of this rare type of breast cancer is unknown.

Fibulectomy for primary proximal fibular bone tumors: A functional and clinical outcome in 46 patients

Background: Primary benign and malignant tumors of the proximal fibula are not very common. Upper fibula being an expendable bone; the majority of the primary bone tumors at this site are usually treated with en bloc proximal fibulectomy. There is scarce literature on functional results, difficulties faced during dissection when to preserve or sacrifice common peroneal nerve and importance of lateral collateral ligament repair after proximal fibulectomy. The present study attempts at assessing these variables. Materials and Methods: This retrospective study included 46 patients; 30 males and 16 females with age ranging from 12 to 44 years (average: 26 years) operated between 2003 and 2014. There were 34 benign and 12 malignant tumors. All were treated with proximal en bloc fibulectomy as indicated and decided by the operating surgeon keeping in view its extent on magnetic resonance imaging. Peroneal nerve sacrifice or preservation was decided as per the type (benign/malignant), its involvement by the tumor and the extent of the tumor. In 14 (for 12 malignant and two benign giant cell tumors [GCTs]) patients, the peroneal nerve required resection for the margins. Partial upper tibial resection was performed in cases of malignant tumors and three GCTs. The followup ranged between 24 and 120 months (median: 48 months). Results: Patients with peroneal nerve resection had inferior functional outcome than those without peroneal nerve resection. There was no higher risk of tibia fracture in patients with partial tibial resection. Lateral collateral reconstruction yielded better results and should be performed in all cases. Functional outcome was significantly better in patients with benign tumors than in patients with malignant tumors as these required neither resection of the peroneal nerve nor large amount of muscle excision. The functional results were evaluated using Musculoskeletal Tumor Society (MSTS) score, and clinical outcomes were evaluated using knee and ankle movements and stability. The overall average MSTS score was 26.50. Conclusions: With good reconstruction of lateral ligament we can achieve good results after proximal fibulectomy for benign as well as malignant tumor without much instability. With partial upper tibial resection (i.e., the extra-articular resection of proximal tibiofibular joint) adequate margins are feasible even in malignant tumors.

Endocervical and vaginal tuberculosis: series of three cases.

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Cytological Features of Granulomatous Mastitis-A study of ten cases

Introduction: Granulomatous mastitis is a rare benign disease, the exact cause of which is still unknown. It usually presents as a mass which may simulate carcinoma. Many patients are put on long term antibiotics because of breast abscess suspicion, but are not cured. This disease usually affects women of child-bearing age with a history of oral contraceptive use. Most cases have been reported in third decade. In previous studies most of cases of idiopathic granulomatous mastitis were within six years of pregnancy. There are two types of granulomatous mastitis, specific and idiopathic. Aim: To study cytological features of granulomatous mastitis, the age group involved and how to differentiate it from malignancy to prevent unnecessary mastectomies. Method: FNAC was performed with 22G needle. Slides prepared were stained with leishman stain. Special stains like Zeihl Nelson stain and Periodic Acid Schiffs were done to rule out mycobacterium and fungal etiology. Result: Cytological features of noncaseating granuloma along with plenty of polymorphs in the background is suggestive of granulomatous mastitis. History of lactation and oral contraceptives along with special tests further aids in its diagnosis. Conclusion: In this study of ten cases we describe the importance of cytology in diagnosis of granulomatous mastitis which helps us to prevent unnecessary mastectomies. GM is essentially a diagnosis of exclusion that is by excluding other causes of chronic inflammation. Infective causes such as tuberculosis should always be ruled out before stating treatment with steroid.

Leukaemic pleural effusion as a manifestation of acute myeloid leukaemia: a case report and review of literature.

Haematologic malignancies such as acute and chronic leukaemias rarely present with or develop pleural effusion during their clinical course. We present a case of a young female who presented with unilateral pleural effusion and was diagnosed with haematologic malignancy on pleural fluid cytology. On further workup, a diagnosis of acute myeloid leukaemia was established. The patient was put on chemotherapy thereafter. This case clearly highlights the importance of cytopathology aids in making a diagnosis of rare and unusual presentation in haematologic malignancies.