Axillary nodes status is the best single predictor of disease outcome in patients with breast cancer; presence ofaxillary node metastasis (ANM) reduces the patient's 5-year survival by 28-40%. However, ANM is seen in only 40% of all breast cancer and furthermore since axillary lymph node dissection (ALND) is associated with significant morbidity, sentinel lymph node biopsy (SLNB) seems to be a good alternative for nodal staging in breast cancer. Pathologically negative sentinel lymph node (SLN) is able to predict the absence of metastasis to the remainder of the regional lymph node basin with a very high degree of certainty. This article presents a systematic detailed review of the existing studies on SLNB in relation to the following parameters: sensitivity and accuracy of the different techniques used; pathologic evaluation of SLN; clinical and pathological factors affecting SLN status and role of SLNB in different clinical situations related to breast cancer management. We have also included brief mention of our experience at UMass from a pathological perspective in this review article.

Clear cell sarcoma of the kidney (CCSK) can display diverse morphological patterns and mimic various other pediatric renal tumors. An accurate diagnosis of this tumour is important considering the therapeutic and prognostic implications. AIM: The present study was undertaken to describe the various histological patterns of CCSK. The histology of 7 cases and the available case files of CCSK accrued over a period of3 years were reviewed. Immunohistochemical (IHC) stains were performed in 3 cases. The histological patterns observed in this study were classical (observed in 4 cases), epithelioid trabecular, myxoid, palisading and hyaline sclerosis types. IHC revealed reactivity to vimentin and non-reactivity to cytokeratin, desmin, smooth muscle actin, neuron specific enolase (NSE) and S-100 protein. Since CCSK is essentially a histological diagnosis, the importance of an accurate diagnosis of CCSK by a pathologist cannot be overemphasized. This study describes the various histological patterns that can be observed in CCSK.

Tumoral calcinosis (TC) is a distinct pathologic entity of obscure etiology, characterized by soft tissue calcium deposition. We analyzed 64 cases retrieved from surgical records over the last 15 years, to assess the disease pattern and recognize the various stages of the evolution of this lesion. In our study, most patients were women (53/64 cases), 47 of whom were postmenopausal, aged 51-70 years, belonging to lower socioeconomic strata, and involved with household chores. The hip was the most frequently affected site. Repeated trauma probably triggered calcium chelation and deposition at this site. Histologically, 10 cases belonged to stage II and 54 cases to stage III. Fully developed lesions showed chips of calcium surrounded by thick fibrosis, mimicking calcified parasite like the Guinea worm. Precursor lesions seen at the periphery of the main lesion suggests a possible etiological role for trauma. Postmenopausal hormonal imbalance, along with poor nutrition and repeated trauma led to TC in our women population. Awareness of its evolution can lead to a better understanding of the disease with possible therapeutic implications.

Gastro-intestinal stromal tumours (GIST) are a biologically distinct heterogenous group of tumours of the gut. They are said to arise from interstitial cells of Cajal in gut wall. The turnour results from mutation of c-kit gene which codes for CD117 containing tyrosine kinase receptor of Cajal cells. Identification of this mutation by immunohistochemistry (IHC) is the key to the diagnosis of these tumours. CD117 negative GISTs develop from gene mutation through alternate pathway (PDGFRA). The accurate diagnosis is important as specific chemotherapeutic agents are now available for their management. We have studied 8 cases of GISTs during last 2 years in our institute. Half of the cases were female, six cases were in the age group between 35 to 50 years, the other two being of 19 and 70 years. On histology, 5 cases were categorized as high grade on the basis of their size and mitotic count. All cases were subjected to IHC. Only 4 cases were CDll7 positive, one case was positive for S100 and one case for SMA. Remaining 2 cases, negative for CD117, S100 and SMA, histologically resembled GISTs. CD117 positive cases are ideal candidates for treatment with molecularly targeted specific chemotherapeutic agents, e.g., imatinib as these tumours are non-responsive to conventional chemotherapy. Histologically diagnosed stromal tumours of the gut should be subjected to immunostain for CD117 so that specific medical management can be provided to prevent recurrence and metastasis as well as pre-operative debulking of the tumour.

Cancer of breast and cervix reign supreme among the fatal diseases in women globally. Interestingly the ovarian cancer has the highest mortality rate. This is attributed to its late clinical presentation and delayed diagnosis. The expression of p53 throws light on the prognosis of ovarian tumors. The surface epithelial tumors, especially the serous cystadenocarcinoma and non Hodgkin lymphoma of ovary where in the expression p53 was high compared to the benign and borderline tumors. Further the expression of p53 in tumors arising from germinal cells, sex-cord stromal cells are observed to be very low. The expression of p53 and its correlation to the morphology enhances the prognostic significance.

The aim of this study is to analyse the morphological pattern of different types of myopathies including morphometric data. The cases were diagnosed as myopathy on the basis of clinical details, EMG findings, serum CK values. Muscle biopsies were performed and hematoxylin & eosin stain and Masson's trichrome stain were done. Muscle fiber diameters were measured using an eye piece micrometer of 100 fibers in each biopsy, these values were plotted and histograms were constructed. From this, mean fiber diameter (MFD), standard Deviation (SD), atrophy factor (AF), hypertrophy factor (HF) and variability coefficient (VC) were calculated. Degree of inflammation was scored semiquantitatively and presence of degenerating fibers, regenerating fibers, perifascicular atrophy, perivascular lymphocytic infiltration and vasculitis were noted. Out of 25 patients, 9 patients of inflammatory myopathy were adults, of the 16 patients of dystrophy 9 patients were adults. Along with weakness of limbs, skin rash was seen in 2 patients of dermatomyositis. Degree of inflammation was more in the patients of inflammatory myopathy than in the patients of dystrophy. Necrotic and regenerating fibers were seen in both groups. Perifascicular atrophy was seen in 1 case of dermatomyositis. Atrophy factor was higher in cases of dystrophy and so was hypertrophy factor. Variability coefficient >250 was found on 90% of dystrophy cases and it was <250 in the cases of inflammatory myopathy. Morphometry provides valuable data, which helps in distinguishing dystrophy from cases of myopathy with inflammation.

This study is conducted to evaluate prognostic significance of recently introduced WHO (World Health Organization) 1999 grading system for urothelial carcinoma on transurethral resection of urinary bladder tumor (TURBT) specimens reported during the period from 1996 to 2000. Progression free survival estimates were obtained by Kaplan-Meier method on SPSS software with log rank test application. Among 70 cases, progression occurred in 38 patients from which grade I were 3, grade II were 11 and grade III were 24. The mean period from diagnosis to progression was 76.8, 19.2 and 3.5 months for grade I, II, III respectively. The progression free survival rates at one year were 100% for grade I, 42% for grade II and 5% for grade III. (Log rank test: p < 0.001). WHO 1999 grading system can classify urothelial carcinomas into prognostically different groups, which is statistically significant.

Gastrointestinal tract is the most common site for the development ofextra nodal lymphoma. This study was done to analyze clinical and pathological features as well as the treatment outcome of this disease. We carried out analysis of25 cases of primary gastrointestinal (GI) lymphomas during period from March 2001 to February 2003 at Gujarat Cancer & Research Institute. Out of 25 cases of primary GI lymphoma, nine cases of gastric lymphoma, nine cases of small intestinal lymphoma and seven cases of large intestinal lymphoma were identified. A male to female ratio of 2.6:1 was observed. Peak incidence was observed infirst and second decades of life (range 4-63 years). Abdominal pain and abdominal lump were the two most common presenting symptoms. Diffuse large B-cell type and Burkitt's lymphoma were the most common histologic variants, accounting for equal proportions (36% each). All the patients were treated with either surgery alone or in combination of surgery, chemotherapy and radiotherapy depending on the site, stage and histology. Anti H-pylori kit was used in early stage GI maltomas. 18 cases of GI lymphoma were evaluable, and out of these, 66.6% (11 cases) attained complete remission with a median follow up time of 12 months. The disease free survival was 50% (9 cases), and the overall survival was 72.2% (13 cases). In conclusion, although there are considerable therapeutic controversies, surgery with adjuvant chemotherapy and radiotherapy yield good survival. Clinical and histopathologic characteristics and prognosis of our cases with primary gastrointestinal lymphoma were usually similar to the cases in western countries with some differences in the incidence and histologic subtypes.

A retrospective analysis of 1592 renal biopsies received from various hospitals all over Kerala over a period of two years was done. Of the 1544 native kidney biopsies majority of cases (300; 18.84%) were focal segmental glomerulosclerosis. Next infrequency was IgA nephropathy (227; 14.26%). The other diagnoses included post infectious glomerulonephritis (GN) (150; 9.42%), lupus nephritis (131; 8.23%), membranous glomerulonephritis (118; 7.41%), minimal change disease (94; 5.94%), interstitial nephritis 87(5.46%), membranoproliferative glomerulonephritis (MPGN) and severe glomerulosclerosis (74; 4.64% each), IgM nephropathy (72; 4.52%), acute tubular necrosis and diabetic glomerulopathy (24; 1.5% each), ANCA-related GN (21;1.32%), amyloidosis (13; 0.82%), Henoch Schonlien purpura (12; 0.75%) atd thrombotic microangiopathy (10; 0.63%). Afew others like myeloma cast nephropathy, cholesterol embolism, Clq nephropathy, oxalosis, mixed connective tissue disorder (MCTD, Wegner's granulomatosis etc. also were seen occasionally. 48 cases were allograft biopsies (3.02%).

This study highlights the rare presentation of anaplastic large cell lymphoma as primary bone and soft tissue tumour. Twelve cases were studied. Clinical impression was non Hodgkin's lymphoma in 4 cases, sarcoma in 6 (osteosarcoma-2, Ewing's/primitive neuroectodermal tumour-1, and sarcoma NOS-3), and tuberculosis of thoracic spine in 1 and the last case involving the rib had a differential diagnosis of tuberculosis and NHL. Histology revealed round cells with eosinophilic cytoplasm and pleomorphic nuclei. Immunohistochemically all tumours were CD30 positive and 8 of 9 cases (88.9%) showed ALK-1 positivity. The pleomorphic cytomorphology ofALCL leads to confusion with the more frequent bone and soft tissue sarcomas affecting the musculoskeletal system. A high index of suspicion is necessary to initiate the correct panel of immunohistochemical markers to first confirm the lymphomatous nature of this tumour and to subsequently subclassify. This alone will lead to an accurate recognition of ALCL and the appropriate chemotherapy.

The diseased gallbladder is one of the commonest specimens submitted to the surgical pathology laboratory in North India. Obesity is associated with a linear increase in gallstone formation. It has been observed that the plasma lipoprotein profile of patients with gallstones differs markedly from that of healthy subjects. Serum lipid profile was done by enzyme kit method. All the gallstones received were categorized morphologically and examined biochemically. The age range of 200 cases was 13 to 77 years with a mean of43.75 +/- 13.39 years. There were 171 females (85.5%) and 29 males (14.5%) with male to female ratio of 1: 5.8. The stones containing both cholesterol and bile pigments were the most common (129 cases, 84.87%); while pure cholesterol stones were seen in 23 cases (11.50%) and pigment stones were infrequent (1 case, 0.65%). On lipidogram of patients in the study group, mean serum total cholesterol was 155.50 +/- 43.03 mg/dL, mean serum triglycerides was 100.49 +/- 45.23 mg/dL, mean HDL cholesterol was 46.71 +/- 15.20 mg/dL, mean LDL cholesterol was 87.94 +/- 36.85 mg/dL and mean VLDL cholesterol was 20.84 +/- 11.97 mg/dL. Serum total cholesterol values were significantly higher in patients older than 39 years as compared to patients < or =39 years (161.44 +/- 42.32 mg/dL vs. 145.79 +/- 32.96 mg/dL, p < 0.05). But the observed mean values in both of these subgroups were within the normal range i.e. <200 mg/dL. No significant difference was observed in the mean serum triglyceride values between male and female patients. The findings of this study did not indicate any role of serum lipid profile in the formation of gallstones. However the higher mean values of serum total cholesterol and serum triglycerides in patients older than 39 years of age may be explained by increasing age.

Pheochromocytoma is an uncommon tumor and occurrence of bilateral malignant tumor is extremely rare. Labile hypertension is the common presenting feature of pheochromocytomas. Herein we describe one such case ofbilateral malignant pheochromocytoma, which was clinically silent except for pain and mass in hypochondrium. Histopathology showed features of malignancy along with hyaline globules, which are less described with malignant tumors. Electron microscopy showed neurosecretory granules in tumor cells.

Primary breast lymphoma is a relatively uncommon neoplasm, majority being of B-cell origin. Mucosa associated lymphoid tissue (MALT) is one of the common types of breast lymphomas. Though cytologic diagnosis of breast lymphoma is an easy procedure and provides guidance for appropriate pre-operative management, it is often impossible to differentiate a low grade lymphoma from reactive proliferation. A similar difficulty was encountered in the present case, a 42 year old female with a breast lump. Fine needle aspiration cytology revealed a mixed lymphoid cell population. Lymphoepithelial lesions were identified histologically, and the majority of the cell population were confirmed as lymphoma cells of B-cell origin on immunohistochemistry. This case highlights the limitations of cytology and the importance of histological examination supported by immunohistochemistry for making a diagnosis of low grade primary breast lymphoma.

Teratoid Wilms' tumor with raised serum alpha-fetoprotein level is an unusual type of tumor. We, here, describe a twelve month old boy presenting with lumbar mass. Clinical features, radiological findings, gross examination, and histomorphological features are studied, and various differential diagnoses like Wilms' tumor with heterologous elements, intrarenal teratoma and metastatic germ cell tumor are taken into consideration.

Although rhinsporidiosis caused by Rhinosporidium seeberi is known to mankind since hundred years, many aspects of this enigmatic disease have remained mysterious till date. Parotid duct as a site of involvement has rarely been reported. Our case interestingly presented with a cystic mass of left parotid duct accompanied by an ulcer and mucopurulent discharge was finally confirmed to be a case of rhinosporidiosis by histopathological examination.

A 15-year-old girl presented with rapidly developing ascites and bilateral tender pelvic masses, diagnosed as small cell carcinoma of the ovary, based on histopathological and immunohistochemical features. The case is being presented because of its rare occurrence.

Merkel cell carcinoma is an uncommon, highly malignant, primary cutaneous neuroendocrine tumour mostly occurring as a solitary nodule on the head or on the extremities. It has high recurrence rate. We hereby report a case of Merkel cell carcinoma in a young woman.

Myofibroblastoma of breast is an extremely rare, benign mesenchymal lesion composed ofmyofibroblasts. Less than seventy cases of this entity are reported in the literature. In spite of the widely varying morphological patterns, there are few characteristic cytological, histopathological, immunohistochemical, and ultrastructural features that permit its accurate identification among a vast group of mammary spindle cell tumours. We present the case ofa 60 year male presenting with a left breast nodule, interpreted as gynaecomastia on cytology. Histopathology however revealed characteristicfeatures of a myofibroblastoma, confirmed by immunohistochemistry.

Juvenile hyalinefibromatosis (JHF) is a rare autosomal recessive (4q21) genodermatosis characterized by a triad of cephalic fibrous outgrowths, gingival hypertrophy and flexion contractures. This paper presents a case report of juvenile hyaline fibromatosis.

Malignant transformation of the epithelial component of Warthin's tumor is extremely rare. We describe our experience of mucoepidermoid carcinoma arising in Warthin's tumor of the parotid gland in a 35 year old female. The tumor removed from the parotid region was well encapsulated and histologically comprised ofmucoepidermoid carcinoma along with areas of Warthin's tumor. The pathogenesis and differential diagnosis of this rare occurrence have been discussed.

Microcystic adenomas of the pancreas are rare benign neoplasms that occur most frequently in elderly females. Characteristically, the tumors have a spongy gross appearance and are composed of innumerable cysts lined by flat, and cuboidal cells which are rich in glycogen. They commonly present with abdominal discomfort or pain. In this case report, we present a cystic neoplasm of pancreas in a 65-year-old lady who clinically presented with discomfort in the abdomen and hyperglycaemia. Proximal pancreatectomy was done. Histopathological examination of surgical specimen confirmed the diagnosis of "Microcystic Adenoma ofPancreas". Despite of the rarity, microcystic adenoma should kept in the mind as the differential diagnosis of cystic lesions of pancreas.

Tumours of the renal pelvis are rare. We present a case of primary mucinous adenocarcinoma of the renal pelvis masquerading as pyonephrosis clinically and diagnosed on histopathologic examination. Patient presented with pyonephrosis of the left kidney due to a large staghorn calculus and was treated with tube nephrostomy followed by nephrectomy.

Renal angiomyolipoma is a distinctive benign neoplasm that occurs either sporadically or in patients with tuberous sclerosis complex. A 45-year-old woman was admitted with history offlank pain and vomiting. There were no signs suggestive of tuberous sclerosis either in the patient or her family. At operation, she had a left renal mass with nephrolithiasis and hydronephrosis. Histopathology revealed epithelioid angiomyolipoma of the left kidney with chronic pyelonephritis. Immunohistochemistry confirmed the diagnosis of angiomyolipoma. This case is presented to highlight the epithelioid variant of angiomyolipoma which may behave in an aggressive manner.

Infantile hemangioendothelioma, the commonest mesenchymal tumour of liver in infancy, though benign in nature, may behave aggressively. Here reports of two such cases are presented. Both were girls and less than 1-year old. Grossly, they presented with nodular hepatic masses with features of heart failure. Histopathology of both liver masses showed intercommunicating bloodvessels, lined by single layer of plump endothelial cells showing CD-34 positivity by immunohistochemistry. Entrapped biliary channels within tumour mass showed cytokeratin positivity.

Disseminated peritoneal leiomyomatosis (DPL) is an exceedingly rare condition that simulates metastatic tumour and mostly occurs in women of reproductive age group subjected to an altered hormonal milieu, usually pregnancy. Here we report a case of a pregnant 28 year female with DPL, spontaneously regressing after pregnancy.

Ocular and extraocular cysticercosis is a commonly encountered manifestation of the disease caused by the cysticercus cellulosae. Any region of the eye may be afflicted including the subconjunctival space. We present the case ofa young female who developed a small mass at the medial canthus of the left eye, which was diagnosed as conjunctival cysticercosis subsequent to excision and histopathological examination.

Acanthamoeba species are free-living amoebae that are the causative agents of chronic granulomatous meningoencephalitis, amoebic keratitis, pulmonary lesions, cutaneous lesions and sinusitis. Immunocompromised individuals are particularly susceptible to infections with Acanthamoeba, which can be disseminated at times. We herewith report the autopsy findings of disseminated Acanthamoeba infection in a 36-year-old female, a renal transplant recipient on immunosupressants for last four years. Central nervous system showed Acanthamoeba associated chronic granulomatous meningoencephalitis, with predominant perivascular infiltrate of amoebic cysts, trophozoites and inflammatory cells. Both lungs and pancreas also showed infiltration with Acanthamoeba.

Chondroid syringoma or mixed tumor of the skin is an uncommon tumor that typically presents as small, solitary, slow growing, firm, subcutaneous or intracutaneous nodule. It presents commonly in the head and neck region. This is a case report of 45-year-old female who presented with multiple masses in the flank, chest wall, arm, -thigh and neck measuring 10, 6, 3.5, 2 and 1 cm in maximum dimension. FNAC and excision biopsy revealed benign chondroid syringoma. This is a rare case of chondroid syringoma exhibiting large size, multiplicity and unusual locations in flank, chest wall and thigh.

Steroid cell tumours (SCTs) account for less than 0.1% of all ovarian tumours. Three major categories ofSCTs include (1) stromal luteoma, (2) steroid cell tumour not otherwise specified and (3) Leydig cell tumours that do not have another component. Stromal luteomas constitute 20% of SCTs. They usually occur in postmenopausal women and about 60% present with estrogenic manifestations. We report a case of stromal luteoma in an elderly lady who presented with postmenopausal bleeding secondary to endometrial hyperplasia. An interesting finding in our case was the presence of many eosinophilic hyaline globules scattered throughout the tumour, the significance of which remains to be determined.

This is a case report of an endodermal sinus tumour arising in the stomach of a 1 1/2 years male child. The tumour occupied full thickness of fundus and part of the body of the stomach. H&E sections of the tumour tissue showed endodermal sinus tumour with predominantly reticular and endodermal sinus patterns. Elevated level of alpha-fetoprotien was detected in the serum of the patient and within the tumour tissue by immunohistochemical technique.

Smooth muscle tumors of the alimentary tract are uncommon.Cancer of small intestine comprises less than 20% of all malignant tumors. A 65-year-old male patient was admitted with complain of pain in abdomen since 7 days. He was diagnosed as a case of acute intestinal obstruction and on laparotomy an extraluminal mass was found at jejunoileal junction. Histopathology revealed a malignant gastrointestinal stromal tumor (GIST) which was confirmed by immunohistochemistry. The case is reported with review of literature and criteria for differentiation between benign and malignant tumors are enumerated.

Sirenomelia is a rare and interesting congenital anomaly where there is fusion of the lower limb buds in association with a number of other anomalies, together termed as the caudal regression syndrome. We report this syndrome in a male foetus of 33 weeks gestational age, and review its embryological basis.

Clear cell ameloblastoma is an odontogenic tumour with aggressive behaviour usually noticed in 6th decade of life. It is histologically characterized by an ameloblastomatous component intermixed with an extensive clear cell component. Here is a case report of an unusual occurrence in a 5-year-old child. The rarity of this tumour and young age of the patient are some of the rare features, which need documentation. The importance of its diagnosis and various differential diagnoses are discussed.

OEIS Complex is a rare congenital multisystem defect that consists of omphalocele, exstrophy, imperforate anus and spinal defects. We report a case of such complex with additional major cardiac and other multisystem anomalies which are rarely described in literature. The authors give a review of literature on this infrequent complex along with a discussion on its pathogenesis, differential diagnosis and prenatal diagnosis.

A 36-year-old man presented with history suggestive of intracranial space occupying lesion. Computed tomography of brain revealed a large lobulated, extra axial, hyperdense lesion in the right fronto-temporal region extending up to to the right frontal and ethmoidal sinuses, eroding the bone, enhancing homogeneously with contrast, which was suggestive of atypical meningioma. He had no predisposing factors that could lead to the suspicion of opportunistic infection. Craniotomy and total excision of the lesion was done. Histopathological study revealed aspergilloma.

Fat containing lesions of the thyroid gland are a rarity with very few cases reported in the literature. We report a case ofa thyroid nodule with adipose metaplasia in a nodular goiter in a 67-year-old female.

A 45-year-old woman presented with a mass in the right hypochondrium and shortness of breath. The mass was felt up to 4.5 inches below the right costal margin and its dullness on percussion was continuous with liver dullness. Ultrasonography (USG) of abdomen revealed enlargement of the left lobe of the liver with multiple cysts of varying sizes. Left liver lobectomy was done, histology of which showed multiple cysts lined by cuboidal to columnar epithelium. A small amount amount of normal liver parenchyma between the cysts was observed. A diagnosis of Adult polycystic liver disease (APLD) was given.

A 30-year-old male was admitted with bilateral painful breast enlargement of 6 months duration. There was a past history of surgery for similar bilateral swellings, which was then diagnosed as fibrocystic disease. On examination both breasts were firm to hard, tender & adherent to deeper structures. A single axillary lymph node was palpable on each side. The clinical diagnosis was sarcoma of the breast. After initial denial, the patient confessed to having injected gear oil into both the breasts,for the purpose of augmentation. He was a homosexual.

Although squamous cell carcinoma of the cervix is the commonest gynaecological malignancy in India, squamous cell carcinoma of the endometrium is rare. Direct extension from the cervical growth can involve the uterine corpus but superficial spread without invasion of the underlying myometrium is uncommon. We report a case of squamous cell carcinoma in-situ of the cervix with superficial extension to the endometrium and both fallopian tubes with simultaneous involvement of both the ovaries.

We report here a case of 40-year-old female admitted in view of bilateral ovarian tumors. There was past history of modified radical mastectomy. CT scan revealed a uterine cervicalfibroid in addition to bilateral adnexal masses. Lobular carcinoma metastasis were seen in the leiomyoma as well as in the bilateral ovaries. Metastasis of ductal carcinoma to uterine leiomyoma have been reported in literature. The present case is unique in two ways--(1) metastasis of lobular carcinoma (2) occurring in a cervical leiomyoma.

A 46-year-old man had primary pulmonary symptoms of intermittent fever, cough and dyspnoea. Radiological investigations revealed a mass at right hilum with right upper lobe collapse. Bronchoscopy showed a luminal mass of which the biopsy showed a tumour with predominantly clear cell change. Subsequent investigations revealed primary renal adenocarcinoma. The differential diagnosis of clear cell lung tumour is discussed. This case of endobronchial metastasis from renal cell carcinoma is being presented because of its rarity.

Isolated intracranial Rosai Dorfman disease (sinus histiocytosis with massive lymphadenopathy) is rare. We present a 26-year-old male who presented with left focal motor seizures becoming secondarily generalized of one-year duration. Clinically and radiologically patient was diagnosed to have a right parietal convexity meningioma. However on histopathological examination a final diagnosis of intracranial Rosai Dorfman disease was rendered.

Primary oral malignant melanomas are rare with an incidence of .2 to 8% of all melanomas. Less than 1% of them arise on buccal mucosa. Grossly they arise as a black macule with irregular borders & are commonly of mucosal lentiginous type. They appear at a higher stage and are aggressive with a 5 yr survival rate of 10-25%. 39% of metastasis in thyroid occur from skin (melanomas) and melanomas produce a thyroid mass while the original source remains occult. We report a case of oral malignant melanoma of left buccal mucosa for its rarity and its spread to cervical lymph nodes and thyroid.

Liposarcoma of the paratesticular region is a rare malignant soft tissue neoplasm. Out of all the possible sites of liposarcoma, the incidence in spermatic cord is rare, accounting for only 5% of these neoplasms. Among the various subtypes of liposarcoma described in the paratesticular region, myxoid variant of liposarcoma is seen very rarely. One such case is we ported here for its rarity and also to draw attention to the fact that, early diagnosis and complete excision carry better prognostic value.

Parathyroid carcinoma is often misdiagnosed as thyroid carcinoma clinically and also with fine needle aspiration cytology. Moreover in cases misdiagnosed as thyroid carcinoma pre operatively, raised urinary catecholamines may mislead to a diagnosis of MEN2 A. We report a case of a patient admitted to the surgery department ofour hospital with a swelling in the thyroid region, raised urinary catecholamines and urinary VMA levels, with hypercalciuria and elevated parathyroid hormone levels. It was clinically suspected as thyroid carcinoma with parathyroid adenoma and associated MEN 2A syndrome.

Chondrometaplasia of larynx is a rare entity with an unknown etiopathogenesis. The lesion remains asymptomatic unless it reaches a large size and a history of trauma is usually elicited. It is a known pitfall in diagnostic evaluation and a clinically significant differential considered in evaluation of cartilaginous tumors of the larynx. A 66-year-old man presented with a nodular mass of right side of neck, progressive hoarseness of voice and pain, and a suspicious growth in the right glottic region. A CT followed by an MRI one month later revealed a slow growing ill defined thickening and enhancement of the supraglottic soft tissues, predominantly involving the submucosa, along the greater cornu on the left side of the thyroid cartilage, with extra-chondral enhancement and was suggested to be of infectious etiology. On neck exploration a lesion clinically suspected to be a chondrosarcoma was excised along with the right ala of the thyroid cartilage. The tissue processed entirely, revealed features consistent with chondrometaplasia of larynx. The importance of distinguishing this lesion from cartilaginous tumors is emphasized.

An eighteen year old male presented with hemoptysis and superior vena caval syndrome. History and clinical examination revealed a testicular mass which was previously diagnosed as hematocele. Chest x-ray showed a four cm diameter shadow and several smaller shadows. Histological examination of the testicular mass established it as immature teratoma with choriocarcinoma-like lesion (CCLL)--a rare association in testicular tumours. Focal positivity for betaHCG was noted in the testicular tumour. Guided aspiration of the lung showed features of a metastatic non seminomatous germ cell tumour.

A case of a female patient aged 60 yrs, with metaplastic carcinoma of the breast which is a rare neoplasm is presented. Although it is a tumor of the ductal type, the predominant component of the neoplasm has an appearance other than glandular pattern and more in keeping with other cell types. Metaplastic carcinoma runs a very aggressive course and bears an unfavourable prognosis.

This report documents an unusualfinding of scattered psammomatous-type calcification in a well-differentiated adenocarcinoma of the rectosigmoid colon in a 54-year-old woman. The clinical relevance of this histologic feature is discussed, in light of review of the literature.

Ovarian sex cord tumor with annular tubules is a very rare tumor .Afourteen year old Nepali girl presented with abdominal distension and lower abdominal pain.On laparotomy bilateral ovarian masses were found. It was totally solid on the right side and was partially solid and partially cystic on the left side. The patient had no other symptoms and features of Peutz-Jeghers syndrome. Microscopic examination showed characteristic findings of sex cord tumor with annular tubules on both sides. The patient was doing well 2 months after surgery. The case is presented with review of literature because of the rare clinical presentation.

Prostatic enlargement due to benign adenomatous hyperplasia is very common in elderly males. However, benign mesenchymal tumors, especially true leiomyoma, are rare in prostate. True prostatic leiomyoma has been defined by Kaufman and Berneike as a smooth muscle tumor within the prostate or juxta-prostatic in position, devoid of glandular elements. The recognition of leiomyoma is important because of the potential of malignancy in such cases, and histopathology is the only tool to do so. We describe the case of a 65-year-old male presenting with urinary obstruction for eight months. Per rectal examination revealed an enlarged firm prostate, a trucut biopsy from which showed only stromal tissue. A suprapubic prostatectomy was performed, and histopathological examination revealed a benign smooth muscle tumor (confirmed by immunohistochemistry), in absence of glandular hyperplasia. Thus, a diagnosis of true leiomyoma of the prostate was made. True leiomyoma is a rare tumor in prostate, which can be diagnosed only on histopathological examination. In addition, careful intra-operative and extensive pathologic assessment is mandatory for predicting the potential behaviour.

Teratomas showing organoid development of intestine are rare. Such cases are mostly described in ovary and sacrococcygeal region. We describe the clinical, radiological and pathological findings of an unusual case of teratoma with colonic loops in a three months old child in retroperitoneal location.

Papillary carcinoma is the most common malignant tumour of thyroid gland which can occur in any age group with most tumours diagnosed in the third and fifth decades predominantly in the females. FNAC is emerging as the first line of investigation for any thyroid enlargement including tumours as a safe, rapid and cost -effective procedure. Many studies have reported diagnostic accuracy of FNAC in detecting neoplasms. The present study aims to evaluate the diagnostic accuracy of FNAC in the cytodiagnosis of papillary carcinoma and to highlight the clinco-pathologic correlation. A total of 37 cases were diagnose cytologically as papillary carcinoma, out ofwhich 28 cases were histologically proved. The remaining 9 cases were not available for biopsy. It was observed that careful cytomorphologic assessment with particular attention to cellular arrangement and nuclear characteristics aided in the correct diagnosis.

Superficial cutaneous/subcutaneous nodules, caused by a variety of inflammatory, benign and malignant pathology of diverse origin, are tempting lesion for fine needle aspiration cytology (FNAC). Amongst these, adnexal tumor show considerable overlap, both in clinical manifestation as well as in histopathology. Archieval records of clinical findings, FNAC smears and reports pertaining to 5 histologically proved cases of pilomatricoma (PMX) were analyzed. Different cytological findings were graded + to +++. Pre FNAC clinical diagnoses were sebaceous cyst, tuberculous lymphadenopathy, dermatofibroma, reactive lymphadenopathy and lipoma. PMX was diagnosed on FNAC in 3 cases on finding groups of basaloid cells, ghost epithelial cells, pink fibrillary material and calcium deposits. Other cases were diagnosed as epidermal inclusion cyst with the differential diagnosis of well differentiated squamous cell carcinoma and skin appendageal tumor of undetermined origin in one case each. In all the cases, FNAC established epithelial nature of the lesion, excluding clinically mimicking inflammatory/neoplastic lesions of other origin. FNAC should be followed by excision biopsy to accurately type the epithelial neoplasm.

36 patients with pleural effusion were studied clinically with pertinent investigations and pleural fluid analysis. The pleural fluid analysis was done with routine protocol including study of traditional parameters like protein and cell count and additional parameters like pleural LDH, GOT(AST) and their ratio with serum LDH and GOT respectively. The utility of these parameters was studied critically. Amongst the isolated parameters cell count enjoyed highest (100%) specificity and positive predictive value. LDH ratio had highest (79.1%) sensitivity. Pleural LDH showed highest (52.6%) negative predictive value and diagnostic accuracy (69.4%). Amongst the combination of two parameters protein with LDH ratio had highest (87.5%) sensitivity, cell count with LDH ratio showed highest specificity (100%), positive predictive value (75%) and diagnostic accuracy (88.9%). Amongst the combination of three parameters pleural protein and cell count with LDH ratio and GOT ratio respectively enjoyed best sensitivity (87.5%), specificity and positive predictive value (100%), negative predictive value (80%) and diagnostic accuracy (90.6%). Similarly competent were the combinations offour parameters namely p rotein and cell count with LDH and its ratio and GOT and its ratio respectively. Combination of all parameters exhibited similar degree of utility.

Kimura's disease is an entity which is common in Asia with predilection for males. Earliest reports were from China. Kimura et al reported the case in detailfrom Japan 1948. Cytological diagnosis of Kimura's helps in allaying fears of malignancies in clinicians and patients. When all the cytological features are seen, this diagnosis should be borne in mind, and the differential diagnosis should be ruled out. Here we report 2 cases of Kimura's disease diagnosed on cytology and confirmed on biopsy. The etiology of Kimura's is unknown but a hypersensitivity etiology has been proposed.

Hemangiopericytomas (HPCs) are tumors, constituting 2.5%, of soft tissue neoplasms. Meningeal hemangiopericytomas are rare non meningothelial mesenchymal tumors of the dura. They were classified as angioblastic meningiomas because of their similarity to meningiomas. However, these tumors are now regarded as distinct entities, akin to hemangiopericytoma elsewhere in the body. Few reports have addressed the fine needle aspiration (FNA) cytology of HPC. We present the cytological findings of one such rare case ofprimary meningeal hemangiopericytoma which metastasized to the lymph node. A 47 years male presented with cervical lymphadenopathy of 2 months duration. He was operated twice in the last 4 years and diagnosed atypical meningioma both times. The patient now also had spinal metastasis producing nerve root compression. Aspiration cytology of the node revealed cellular aspirate demonstrating round to oval cells with ample cytoplasm, round nuclei and inconspicuous nuclei. They showed a characteristic ferning out of blood vessels. Occasional mitosis was present. A diagnosis of malignant tumor of vascular origin was offered. Lymph node biopsy showed a characteristic histological picture of hemangiopericytoma described in other soft tissues. The cytology of this tumor is characteristic, but the rarity of the lesion, especially in metastatic sites makes diagnosis difficult unless a high index of suspicion is present. The recognition of the distinct cytological findings makes this possible. The case documents the role of FNA cytology in confirming HPC.

Aneurysmal bone cyst is a relatively rare tumour accounting 1 to 6% of all primary bone tumours. The involvement of clavicle is even rare with incidence of only 3% of all cases of aneurysmal bone cyst. Aneurysmal bone cyst is an expanding osteolytic lesion occurring mostly at metaphyseal ends of the long bones. Although excisional biopsy is diagnostic for aneurysmal bone cyst and FNAC (fine needle aspiration cytology) is mostly inconclusive. Still FNAC can be helpful in pre-operative diagnosis of aneurysmal bone cyst.

In the last decade, hepatitis C has emerged from obscurity as a disease (Non A Non B Hepatitis)familiar to only a few experts, to being recognized as a major public health problem. The present study was done to find out the seroprevalence of hepatitis C virus in 5000 blood donors in Patiala and to compare its seroprevalence in voluntary and replacement blood donors. The testing for HCV antibodies was done by ELISA technique using third generation HCV microlisa kit. Seroprevalence of anti-HCV amongst 5000 healthy blood donors was 0.88%. It was 0.58% in voluntary blood donors and 0.95% in replacement blood donors. Anti-HCV positivity was significantly higher amongst males (0.97%) than females (0.59%). Maximum anti-HCV positivity was seen in 41-50 year age group in voluntary donors and 31-40 year age group in replacement group. This study made us to conclude that above results were due to multiple reasons like transfusion of blood and blood products from unscreened donors, medical injections, tattooing, intravenous drug abuse, traditional medicinal practices, sexual promiscuity and lack ofawareness in rural population about the disease and mode of spread.

Transferrin, the major iron binding protein in human plasma transports iron to various tissues. The first step in cellular iron uptake is binding of transferrin complex to the cell surface membrane by specific molecule known as transferrin receptors. Transferrin receptors are found in limited sites in normal tissues, in contrast, the receptors are widely distributed in majority of carcinomas and sarcomas. Presence of increased transferrin receptors implies a stage of moderate or less differentiation corresponding to elevated proliferative activity and therefore, has a prognostic value. Demonstration of transferrin receptors and its distribution pattern within a tumour as well as its quantitative determination can provide data helpful for, both, an additional understanding of tumour biology and as an approach for planning therapy. In present study, we analysed 60 cases, 30 each of reactive lymphadenitis and lymphomas for transferrin receptors using immunohistochemical technique (DAKO, Code-K0673). Grade II and Grade III intensity was recorded in the germinal centers and the histiocytes in sinus histocytosis indicating the proliferating cells and activated histocytes. Most of the low grade non-Hodgkin lymphomas (83.66%) showed weak (Grade I) positivity for transferrin receptors. Intermediate grade lymphomas showed moderate (Grade II) to high intensity (Grade III) for transferrin receptors (57.14% and 42.85%) respectively. Seventy five percent of high grade lymphomas showed strong (Grade III) positivity. All the 9 cases of Hodgkin lymphoma (100%) showed grade III positivity. Proportion of the cells within a tumour expressing transferrin receptors in high density are therefore likely to represent the growth fraction of the tumour.

Red cell units issued to patient and returned back unused, are visually inspected for hemolysis before releasing them for reissue. A study was conducted to find out effect of temperature interruptions in the red cell units, during transport. The aims were to find out hemolysis in units with temperature interruptions and its relationship to the duration and also to compare actual hemolysis with visible hemolysis, if any. Thirty samples with different duration of temperature interruptions were evaluated for actual hemolysis. Fifteen samples of similar shelf-age but without temperature interruptions were included in the study as controls. Low hemoglobin photometer was used to measure supernatant hemoglobin. Despite temperature interruptions, almost all red cell units had acceptable level of hemolysis and this was similar to the red cell units without temperature interruption. The difference between the units with or without temperature interruption was not statistically significant (p > 0.05). Red cell units with smaller duration of temperature interruptions had lesser hemolysis than in those with longer temperature interruptions (p < 0.05). Red cell units younger than 7 days had lesser hemolysis than the units older than 8 days in both categories of units with and without temperature interruptions (p < 0.05). The units without visible hemolysis had lower hemolysis than units with visible hemolysis (p < 0.05). It can be concluded that temperature interruptions have a very minor role in hemolysis, younger units have lesser hemolysis than older units and visual assessment is subjective and tend to overestimate hemolysis.

Fanconi anemia is an autosomal recessive disorder characterized by phenotypic abnormalities, increased chromosomal breaks and predisposition to various hematological and non-hematological malignancies. We present case report of a paediatric patient with Fanconi anemia presenting as acute myeloid leukemia. The presence of dysplastic features in this marrow suggests the possibility of a prior stage of myelodysplasia progressing to leukemia.

Acute basophilic leukaemia is an uncommon form of acute leukaemia, rarely occurring as de novo disease. Due to rarity of the disease, consistent diagnostic criteria for the identification of this entity still remain the topic of discussion. Immunophenotypic profile, electron microscopy and cytogenetic analysis in addition to morphological features, are said to be highly desirable for correct identification of this entity. In set-up like ours, where such facilities are either not available or not in reach of the patients due to financial constraints, morphological features and simple technique like demonstration of metachromasia in blasts with toluidine blue stain remain the most useful diagnostic tool for identification of this rare condition. We present a case of acute basophilic leukaemia with (11q23)-MLL gene rearrangement, in an 18-year-old male with review of literature and discussion of diagnostic criteria.

Stool samples collected from the districts of Darjeeling, Jalpaiguri, Hooghly and Calcutta in West Bengal were examined for hookworm and associated parasites. It was found that maximum prevalence of hookworm was in Hooghly district (24.8%). N. americanus appeared to be more prevalent species in all the districts studied. The load ofhookworm infection appeared to be mostly in the mild range. Ascaris lumbricoides appeared to the most common accompanying infection. In the affected population, the degree of anaemia was mostly mild.

Renal transplant is usually performed at the end stage of renal disease. Most of the transplant recipients become susceptible to infections due to chronic uremia, protein depletion, anemia and administration of immunosuppressive drugs. It is a retrospective study of 510 post renal transplant recipients. 378 (74%) renal transplant recipients suffered from the infections. Most common site of infection was urinary tract infection (53%). Out of 26% of wound infections, the deep wound infection (23%) was six times higher than superficial wound infection (3.5%). Chest infection and bacteraemia were noticed to be 18% and 8%, respectively. The common isolate was Escherichia coli (160) followed by Staphylococcus aureus (140), Enterococcus (86) and Pseudomonas (69).

The emergence and spread of extended spectrum beta lactamase (ESBL) producing strains have led to questions regarding optimal therapy for infections especially empirical treatment of suspected gram negative infection. A total of400 isolates belonging to family enterobacteriaceae were isolated from various clinical samples and were studied for ESBL production by NCCLS (National Committee for Clinical Laboratory Standards) confirmatory test (using disc diffusion technique) and MIC brott dilution test. ESBL production was found in 61.72% of hospital isolates and 30.90% of outdoor isolates. The susceptibility of ESBL producers to imipenem and amikacin was found to be 100% and 63.38% respectively. A high degree of associated resistance to other antimicrobial was found in ESBL producers. Tests for detection of ESBLs and continuous monitoring of antimicrobial sensitivity pattern in individual setting is emphasized to minimise the emergence of drug resistant bacteria.