Rajeev Sen

Primary hepatic tuberculosis: a rare but fatal clinical entity if undiagnosed.

Hepatic tuberculosis particularly in the absence of military tuberculosis is rare. It can occur as a primary case or due to reactivation of an old tubercular focus. We report case of a 24 year old married female who died of primary hepatic tuberculosis. She had no evidence of tuberculosis elsewhere. Appropriate treatment initiated early can result in marked recovery whereas failure to recognize this entity can prove to be fatal.

Treatment of pathologic femoral neck fractures with modified Pauwels' osteotomy

Treatment of pathologic femoral neck fractures secondary to extensive lesions of fibrous dysplasia and simple bone cysts has been controversial. We think that modified Pauwels’ intertrochanteric osteotomy and osteosynthesis can result in sound healing of the lesion and of the fracture, with no recurrence, low complication rates, and good functional results. Seven patients were treated with a uniform approach consisting of biopsy (Stage I) and osteotomy with osteosynthesis (Stage II). Curettage of the lesion and bone grafting were not done. The average followup was 79.28 months (range, 32-142 months). All of the fractures and osteotomy sites healed in means of 14 weeks (range, 12-16 weeks) and 9.1 weeks (range, 8-10 weeks), respectively. All fibrous dysplasia lesions healed radiologically. Grade IV radiographic healing was seen in both patients with simple bone cysts after 35 and 92 months. Using the Musculoskeletal Tumor Society functional evaluation and Toronto Extremity Salvage Score, all the patients had good to excellent results. Complications such as infection, local recurrence, refracture, femoral neck deformity, osteonecrosis of the femoral head, and growth arrest of capital femoral physis were not seen. In addition to biomechanical advantages, the procedure seems to have had a biologic role in healing of the fracture and of the lesion by initiating osteogenesis to replace the defect with new bone. Level of Evidence: Therapeutic study, Level IV (case series-no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.

Significance of p53 and ki-67 expression in prostate cancer

Background: Prostate cancer is a major health problem throughout the developed world. Tumor grade is one of the most important prognostic factors of prostate cancer. At present, adequate prognostic markers for prostate cancer progression are still lacking, in spite of intensive investigation. Accordingly, we studied the role of immunohistochemical (IHC) expression of p53 and Ki-67 as a prognostic factor in carcinoma prostate and correlated their expression with Gleasons grade. Materials and Methods: In this prospective study, a total of 60 cases including 50 cases of prostate carcinoma and 10 of benign prostatic hyperplasia (BPH) were taken. Tumor grade was determined according to Gleasons grading system. p53 and Ki-67 expressions were determined by IHC staining. The obtained results were analyzed and evaluated using Spearmans statistical test (SPSS version 20). Results: In BPH, p53 was expressed in only 2 of 10 (20%) cases while in carcinoma it was expressed in 38 of 50 (76%) cases. Ki-67 was expressed in only 1 of 10 (10%) BPH cases while in carcinoma it was expressed in 32 of 50 (64%) cases. In present study, 1 of 4 (25%) well differentiated, 23 of 31 (74.19%) moderately differentiated and 14 of 15 (93.33%) poorly differentiated tumors revealed p53 immunopositivity and a statistically significant correlation was observed between p53 expression and increased Gleasons grade (P = 0.038). All 4 (100%) cases of well-differentiated carcinoma were negative for Ki-67 expression. Nineteen of 31 (61.29%) moderately differentiated and 13 of 15 (86.66%) poorly differentiated tumors were positive for Ki-67 and a statistically significant correlation was observed between Ki-67 positivity and increased Gleasons grade (P = 0.002). Conclusions: Both p53 and Ki-67 were significantly up-regulated in malignant lesions as compared to benign lesions and a strong relationship with the Gleasons grading was noticed, therefore, we propose that these markers can be applied along with other prostate cancer prognostic factors.

Fine needle aspiration cytology in lesions of oral and maxillofacial region: Diagnostic pitfalls

Background: Fine needle aspiration cytology (FNAC) of oral and maxillofacial region has not been widely utilized for diagnosis due to diversity of lesion types, heterogeneity of cell populations and difficulties in reaching and aspirating these lesions. Aim: Our aim was to demonstrate the effectiveness of this cheap and simple procedure for the diagnosis of tumor and tumor like lesions of oral and maxillofacial region. In addition, we sought to highlight probable causes of errors in the cases showing lack of correlation between cytological and histological diagnoses. Materials and Methods: The study was conducted on 50 patients of all age groups with various palpable lesions in the oromaxillofacial region. A comparison between cytological and histological diagnosis was done wherever biopsy material was available. Results: The rate of unsatisfactory FNA was 4%. There were six false negative cases but no false positive case. The sensitivity of our study ranged from 77.7 to 75% including and excluding the suspicious cases, respectively. Specificity and positive predictive value was 100%. Conclusion: FNAC is a minimally invasive, highly accurate and cost-effective procedure for the assessment of patients with oromaxillofacial lesions. When applied in a proper manner, FNAC can help avoid a surgical biopsy in many cases.

Tuberculosis of uterine cervix: a report of two cases with variable clinical presentation.

Tuberculosis (TB) of the cervix is a rare disease. We describe two cases of tuberculous cervicitis with variable clinical presentation. In one case, a young woman presented with primary infertility and secondary amenorrhoea. The other is a perimenopausal woman with irregular vaginal bleeding and postcoital blood-stained discharge. The diagnosis was confirmed on histopathological examination of the endocervical curettings and a cervical biopsy. The patients were given six months of anti-tuberculous therapy and responded well.

Histopathologic changes following neoadjuvant chemotherapy in various malignancies

Background: Various histopathological changes have been observed following neoadjuvant chemotherapy in individual tumors in the literature. Aims and Objectives: To observe histopathologic changes seen after neoadjuvant chemotherapy in breast malignancies, squamous cell carcinomas, adenocarcinomas, and Wilms′ tumor using breast cancer predominantly as the model. Materials and Methods: The present prospective study was carried out on 60 patients including 40 patients with carcinoma breast and 20 patients with other malignancies who received neoadjuvant chemotherapy. Results: Post neoadjuvant chemotherapy, mastectomy specimens revealed nuclear enlargement, nuclear shrinkage, necrosis, vacuolation of nucleus, vacuolation of cytoplasm, dyscohesion, and shrinkage of tumor cells with nuclear changes of nonviability like karyorrhexis, karyolysis, and pyknosis. Stromal reactions manifested as fibrosis, elastosis, collagenization, hyalinization, microcalcification, and neovascularization. Areas of necrosis included both vascular and avascular pattern. The stroma also revealed fibrinoid necrosis and mucinous change. Hyalinization of the blood vessel wall was a common finding. The most common inflammatory host response observed in the present study was lymphocytic; others included mixed inflammation, plasmacytic, prominent histiocytic, and giant cell types. Giant cell reaction was significantly correlated to all types of tumor responses (P < 0.05). Similar changes were also observed in other malignancies. A detailed review of the literature has also been done and presented. Conclusion: The tumor grade decreases and differentiation improves, in addition to the retrogressive changes and increase in stromal component, as a result of chemotherapy in carcinoma breast as well as in other malignancies.

Primary neuroendocrine carcinoma of breast

Background: Neuroendocrine carcinoma of the breast is a rare entity. Most patients are in the sixth to seventh decade of life. The criteria for diagnosis were established by the WHO in 2003, and modified in 2013. Based on the limited number of studies done; this entity is thought to have a worse prognosis compared to the usual type of intraductal carcinoma. Case Report: A 45 year old woman presented in the surgical outpatient department with complaint of lump breast. Fine needle aspiration was performed and the case was reported as suspicious of malignancy. Biopsy was advised for further evaluation. Histopathology showed a cellular tumor exhibiting a sheeting pattern with interspersed rosettes. The individual cells were relatively monomorphic, with a salt and pepper chromatin. Intraductal component was also identified. Based on the characteristic morphology and presence of chromogranin positivity in more than 50% of the tumor cells, the lump was diagnosed as primary neuroendocrine carcinoma, well differentiated. Conclusion: This case has been written up because of the rarity of this entity, its characteristic histopathological features, and the importance of differentiating it from intraductal carcinoma, due to a more aggressive course than invasive ductal carcinoma, with a higher propensity for local and distant recurrence and poorer overall survival attributed to this entity by some researchers.

NODULAR FASCIITIS OF THE THUMB: A CASE REPORT

Nodular fasciitis is an uncommon, benign, reactive fibroblastic soft tissue tumour. It is infrequently seen in the hand. A case of nodular fasciitis involving the thumb of a 34-year-old male is reviewed, and its clinicopathologic features are presented. Main significance lies in clinical and pathological recognition of the lesion to avoid over-treatment.

Heterotopic pancreas presenting as ileoileal intussusception

Heterotopic, aberrant or ectopic pancreas is defined as the presence of pancreatic tissue in topographic anomaly, with no anatomical, neural or vascular connection to the normal pancreas. It is a rare condition found mainly in stomach, duodenum and jejunum. Ileal heterotopic pancreas is an uncommon condition and has been rarely reported in children so far. Hereby we report a case of heterotopic pancreas presenting as ileal poyp leading to ileoileal intussusception in a 12 year child.

Intramuscular lipoma of tongue.

1. Rahbar R, Shah P, Mulliken JB, Robson CD, Perez-Atayde AR, Proctor MR, et al. The presentation and management of nasal dermoid: A 30year experience. Arch Otolaryngol Head Neck Surg 2003; 129:464-71. 2. Post G, McMains KC, Kountakis SE. Adult nasal dermoid sinus cyst. Am J Otolaryngol 2005,26:403-5. 3. Lee S, Taban M, Mancini R, Chong K, Goldberg RA, Douglas RS. Endoscopic removal of nasoglabellar dermoid cysts. Ophthal Plast Reconstr Surg 2010;26:136-9. Access this article online