Yogesh Kumar Yadav

A new variant in the brachium musculature with reinforced innervation from a median-musculocutaneous nerve communication

Neural variations of the brachium constitute an important anatomical and clinical entity. Although frequently reported, if accompanied by other anomalies, they deserve special mention in anatomical literature. The goal of this present study is to report a communication between the median (MN) and musculocutaneous nerve (MCN), concomitant with an accessory muscle belly. Interestingly, an important proximal connection between the lateral and medial roots of the MN was also observed. The MCN joined the MN at mid humeral level. The peculiarity of the current report arises due to the presence of a twig passing from the site of communication between the two nerves, to supply the coracobrachialis. Concomitantly, an accessory muscle measuring 5cm in length originating from the short head of biceps brachii, fusing with the coracobrachialis was seen in the mid brachium. The observations of the current study may cause a perplexing situation for anesthetists attempting brachial plexus blocks and for surgeons who operate on this vital anatomical arena.

Cylindroma of the breast: A rare case report

Cylindroma is a benign adnexal tumor, which occurs as solitary dermal nodules on the scalp and forehead. Cylindroma of the breast is a rare lesion. Fine-needle aspiration is often the first line of investigation. In this communication, we illustrate the cytomorphological feature of cylindroma in a 61-year-old female patient who presented with a breast lump. Fine-needle aspiration cytology in this case reveals the islands of tumor cells formed a “jig-saw” pattern, along with the bland, basaloid cells associated with globular, extracellular material. These features are typical of cylindroma, but differential diagnosis of adenoidcystic carcinoma should always be kept in mind as the management of both tumors are different.

Squamous predominant Teratoid Wilms' tumor

Teratoid Wilms tumor is an unusual histological variant of nephroblastoma with predominant heterologous component. Frequently present components include adipose tissue, glial tissue, muscle, cartilage or bone. The presence of squamous epithelial component on the other hand is rarely reported. We describe a case of unilateral teratoid Wilms’ tumor in a 2-year-old boy with lung metastasis. In this case, tumor showed the familiar triphasic histologic pattern of nephroblastoma along with extensive squamous epithelial component.

Rapunzel Syndrome Causing Appendicitis in an 8-year-old Girl.

Rapunzel syndrome is a rare type of presentation of trichobezoar, an extension of hair fibers into the small bowel and rarely beyond the ileocecal valve. Its clinical presentation is deceptive ranging from abdominal mass to symptoms of obstruction. We report a 8-year-old girl admitted with a history of abdominal pain and vomiting off and on for a period of 1 year. Ultrasound findings were suggestive of subacute intestinal obstruction. On laparotomy, trichobezoar was found in the stomach extending into small bowel and was removed. Appendix was inflammed hence it was also resected. Microscopic evidence of a hair shaft was seen in the appendix indicating appendicitis was due to luminal obstruction by hair concretions.

Clinico-embryological perspective of a rare accessory brachial muscle with possible musculocutaneous nerve compression

Both brachialis and biceps brachii are primary flexors of the arm and elbow from the biomechanical perspective. Numerous reports exist in anatomical literature regarding accessory heads of biceps brachii, although such accessory bellies in relation to brachialis muscle are less frequently elucidated. We report a unilateral case of a rare accessory muscle interposed between the biceps brachii and brachialis, having the musculocutaneous nerve (MCN) entrapped between the two. Furthermore, the muscle divided into two slips, upper slip was attached to biceps brachii and the other gained insertion to the brachial fascia. Innervation to this accessory muscle was derived from MCN. The embryological basis for such supernumerary muscle is discussed. Additionally, the case is considered under surgical and clinical perspective, highlighting the importance of familiarity with such variations. Anatomical variations of the brachial musculature may cause diagnostic perplexities while interpreting MRI or CT scans.

Cytological diagnosis of parasites presenting as superficial nodular swelling: report of 35 cases

Parasitic infestation often present with superficial nodular swelling. Fine needle aspiration cytology plays an important role in prompt diagnosis of the disease. To study the role of FNAC in the diagnosis of parasites presenting as skin or subcutaneous nodules. Total 361 cases of superficial swellings at various sites were subjected to fine needle aspiration cytology. Out of the 361 cases, 35 cases were diagnosed as suggestive of parasitic infestation. These 35 cases form the study group. In 14 cases out of 35 cases, a definitive diagnosis of parasitic infestation was made as parasite or fragments of parasite were seen in the aspirate. In 21 cases, neither parasite nor fragments could be identified on the aspirates and a diagnosis of parasitic inflammation was suggested on the basis of other cytomorphological findings. In 17 of these cases, a biopsy correlation was available, which revealed definitive parasite in 8 cases and the remaining 9 were reported as suggestive of parasitic cyst. The cytological diagnosis was confirmatory in cases where the parasite fragment were identified in the smears. However, in other cases, clear aspirate, presence of eosinophils, macrophages and typical granular dirty background are the features which should prompt the cytologist to the possibility of parasitic infestation.

Efficacy of Cytokeratin 19 expression on fine needle aspiration cell blocks in pre-operative diagnosis of malignant thyroid neoplasms

Context: Accurate diagnosis of malignant lesions of thyroid remains a challenge, especially when classical features are lacking on cytological examination. Aims: To evaluate the expression of Cytokeratin 19 (CK 19) on cell blocks made from thyroid swellings diagnosed as papillary carcinoma or follicular adenoma/carcinoma on fine needle aspiration cytology (FNAC) smears. Materials and Methods: Aspirates from fifty patients diagnosed as papillary or follicular lesions on FNAC were enrolled in the study. Cell blocks were simultaneously made along with aspiration using standard cell block techniques. These cell blocks were subjected to Cytokeratin 19 immunoassay using immunoperoxidase ABC (avidin biotin complex). Statistical Analysis Used: Chi-square test for statistical significance and Goldman test for sensitivity and specificity. Results: Evaluation of the expression of Cytokeratin 19 on cell blocks revealed that almost all papillary thyroid carcinomas stained strongly positive while all follicular adenomas and follicular carcinomas were found to be negative for CK 19 immunostaining. The difference in frequency of Cytokeratin 19 positive papillary carcinoma and follicular adenomas was statistically significant. The predictive value of a positive CK 19 test was found to be 100% while that of a negative test was 93.9%. Conclusions: Cytokeratin 19 immunostaining in conjunction with fine needle aspiration cell blocks can be a valuable marker in pre-operative diagnosis of papillary thyroid carcinoma along with its variants (sclerosing and follicular). This can help the clinician in formulation of treatment as papillary thyroid carcinoma is treated by radical measures as against the more conservative approach for benign follicular lesions.

Isolated cysticercosis involving the anterior abdominal wall: a rare case report

Isolated cysticercosis of anterior abdominal wall without parasitosis of central nervous system is very rare and may mimic a tumor leading to diagnostic and therapeutic dilemma. Histopathological examination plays an important role in making a definitive diagnosis. Here we report a case of a 13-year old Muslim girl presenting with swelling and pain in left lower abdomen which was clinically diagnosed as lipoma. On histopathological examination cysticercus with surrounding inflammation was seen. Since cysticercosis is a preventable disease, early and accurate diagnosis is necessary for the reduction of disease burden in the endemic areas.

Accelerated Phase of Chediak-Higashi Syndrome at Initial Presentation: A Case Report of an Uncommon Occurrence in a Rare Disorder.

Chediak-Higashi syndrome (CHS) is an uncommon and fatal congenital disorder. The characteristic features of CHS are partial oculocutaneous albinism, increased vulnerability to infections, presence of abnormal large granules in leukocytes and an accelerated lymphohistiocytic phase. Accelerated phase at initial presentation is rarely seen as it is usually preceded by repeated episodes of infections. Hence this interesting case of a four-month-old Indian child born to consanguineous parents in accelerated phase at initial presentation is described. The boy presented with fever, hepatosplenomegaly, and cleft lip. Clinical diagnosis was leukemia or a lysosomal storage disorder. Cytopaenias, lymphohistiocytic infiltration in bone marrow, and the characteristic large granules in leucocytes helped in the diagnosis, emphasizing the importance of bone marrow in diagnosis of unusual presentation of this rare disorder.

A rare case of minimal deviation mucinous adenocarcinoma of the uterine cervix and review of literature

Minimal deviation adenocarcinoma (MDA) is uncommon and accounts for only 1-3% of all cervical adenocarcinomas, and most pathologists diagnose only one or two cases during their professional life. MDA is unusually well-differentiated adenocarcinoma of the cervix formed by neoplastic cells displaying only minimal cytological atypia. Because of the high degree of differentiation, there is a high frequency of failure to diagnose this malignancy histologically. To better understand the presentation of MDA, we are reviewing the clinical, histological, and immunohistochemistry findings in one case.