Priyanka Gogoi

Intraparenchymal Angiomatous Meningioma: A Diagnostic Dilemma.

Meningioma arises from the arachnoid cap cells of the cerebrum. Intraparenchymal meningiomas or meningiomas without dural attachment are rare. We report a case of 40-year-old male who presented with a history of headache, dizziness and gradual loss of vision since one year. Clinicoradiological diagnosis of a high grade glioma was considered. Tumour was excised and haematoxylin and eosin stained sections revealed a tumour comprised predominantly of variable sized blood vessels showing hyalinization in a background of plump spindle cells with oval vesicular nuclei. In view of these features angiomatous meningioma was suspected. However, to confirm the diagnosis, a panel of immunohistochemical markers including vimentin, EMA and GFAP was done and a final diagnosis of angiomatous meningioma was offered. Angiomatous meningioma is a rare variant of meningioma and even much rarer in the intraparenchymal location. Angiomatous meningioma should be considered in the differential diagnosis of highly vascular intraparenchymal brain tumours.

Fetal Autopsy and Placental Examination as a Complimentary Tool

Recurrent pregnancy loss (RPL) is defined as the loss of three or more consecutive pregnancies and affects 1% of couples trying to conceive; however, a definitive diagnosis is possible in only 50% of cases, and significant number of RPL remains unexplained despite intensive investigations of probable causes. The autopsy of the fetus as well the placental examination can help by providing additional information beyond that achieved by conventionally recommended investigations. The role of routine histopathological examination of evacuated products of conception in determining the etiology of RPL has generated a lot of debate and controversy. The limited amount of material available as well as the fragmented nature of the specimens submitted makes the morphological study particularly challenging. While not recommended as a part of routine workup of a patient of RPL currently, it cannot be denied that such an exercise allows identification of important etiology in few cases while giving direction for further diagnostic workup in others. However in the majority of cases the morphological examination alone is unlikely to alter clinical management. An optimized protocol for the histopathological evaluation of products of conceptus in RPL, supplemented with use of newer advanced techniques including immunohistochemistry, FISH, PCR, and microarray profiling, is the need of the hour to extract maximum diagnostic yield from these specimens.

Osseous metaplasia of ovarian cyst: a rare case report

Osseous metaplasia has been described in many places, but previous reports of osseous metaplasia in ovarian lesions are rare. It is most commonly associated with dermoid cysts, or ovarian teratomas with additional features such as hair, cartilage and muscle, etc. Other causes of this ossification include osseous metaplasia in serous or stromal-rich mucosal neoplasms or mucus. In ultrasound, a hardened endometriotic cyst (brown cyst) may be misdiagnosed as a calcified ovarian teratoma or tumor. The hardened endometriotic cyst (brown cyst) is not an indication of the operation itself, but other lesions are treated primarily by surgery. This type of ambiguity, which occurs after ultrasound, disappears only with the histopathology of the sample resected with clinical correlation.

Neutrophil-to-lymphocyte ratio and platelet indices in pre-eclampsia

To compare the neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), and platelet indices between women with pre‐eclampsia and normotensive pregnant women.

Subungual fibro-osseous pseudotumour of the digit: a rare occurrence

lished by the International Headache Society, the patient was diagnosed with occipital neuralgia. Sodium valproate 400 mg twice per day was administered, and the attack was significantly reduced. Thus we were not required to reduce the dosage of vemurafenib. The dosage of sodium valproate was gradually tapered over 2 months, and the patient had no subsequent complaints of headache. Occipital pain is a common complaint among patients with headache. Occipital neuralgia is an uncommon cause of occipital pain characterized by paroxysmal lancinating pain in the distribution areas of the greater, lesser, or third occipital nerves. Its etiology is unknown, and no epidemiological studies have documented its incidence or prevalence. Physical therapy and antiepileptic drugs have been reported to be effective in reducing the frequency and severity of attacks. Occipital neuralgia associated with malignancy or with anticancer therapy has seldom been reported. The association between occipital neuralgia and vemurafenib is unclear, and occipital neuralgia is not included among the major adverse events listed in the US National Institutes of Health National Cancer Institute’s Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0, and therefore we did not reduce the dosage of vemurafenib. If the pain had not been controllable, the patient would have refused the use of vemurafenib, and we would definitely have terminated the drug. The administration of vemurafenib may have triggered the occurrence of occipital neuralgia, or the occipital neuralgia may have occurred spontaneously. Although we are unable to differentiate which of these occurred in our patient, we believe that this case may highlight the importance of remaining aware of the potential risk for occipital neuralgia in a vemurafenibtreated melanoma patient.

Myoepithelial carcinoma of the tongue- spindle cell morphology with high mitosis: A case report and review of literature

Myoepithelial carcinomas represent <1% of salivary gland tumors. Tongue is a rare site of occurrence. We present a case of a 30 year old female with myoepithelial carcinoma seen over dorsum of tongue with predominantly spindle cell morphology with clear cytoplasm and mitotic count of 6–7/10 hpf. We need to differentiate it from a spindle cell squamous cell carcinoma which can be seen at this location, i.e., tongue. In our case, there was no connection of the tumor with overlying squamous epithelium.

Seroprevalence & changing trends of transfusion-transmitted infections amongst blood donors in a Regional Blood Transfusion Centre in north India

Background & objectives: Transfusion-transmitted infections (TTIs) are the major problem associated with blood transfusion. Accurate estimates of risk of TTIs are essential for monitoring the safety of blood supply. The present study was undertaken to determine the percentage of voluntary donors (VDs) and replacement donors (RDs) and also, to estimate and compare the seroprevalence and changing trends of TTIs amongst VDs and RDs in a regional blood transfusion centre in north India. Methods: This retrospective study was based on the records of all voluntary and replacement donations which were collected from January 2008 to December 2014 in a Regional Blood Transfusion Centre placed in a tertiary care hospital in Delhi, India. Results: Of the total 220,482 donations, 163,540 (74.17%) were voluntary and 56,942 (25.83%) were replacement donation. The overall seroprevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), syphilis and malaria were 0.32, 1.61, 0.73, 1.62 and 0.06 per cent, respectively. Furthermore, the TTIs were more frequently encountered in RDs in comparison to VDs. Interpretation & conclusions: The increase in public awareness regarding voluntary blood donation, meticulous donor screening, counselling and use of highly sensitive tests can help in reducing the risk of TTIs.

Subungual melanoma is not so rare: Report of four cases from India

Subungual melanoma (SUM) is an uncommon form of acral melanoma that arises within the nail matrix. The incidence for acral melanomas is similar worldwide, however, the proportion is higher in dark-skinned individuals. The subungual form represents approximately 2% of cutaneous non-sun-induced melanomas in the western world and up to 75% in Africans, 10% in Japanese, and 25% in the Chinese. No specific figures are available from the Indian subcontinent; however, the authors could trace three anecdotal case reports published over the last two decades. A general reluctance to biopsy a nail lesion to confirm the diagnosis may be contributing to the missed diagnosis. We report four cases of SUM of the big toenails seen over a period of 2.5 years. They were three women and one man with an age ranging from the 4th to 7th decade and disease duration of 6–18 months. The lesion involved the big toe in all and two patients had liver and lymph node metastasis at the time of presentation. Awareness among dermatologists regarding clinical manifestations, high index of suspicion for acral pigmented lesions, and nail bed biopsy may help in the early diagnosis and management and can prevent mortality.