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Uterine arterio-venous malformation is one of the differentials of dysfunctional uterine bleeding that can result in life-threatening emergency with sudden, unexpected massive vaginal bleeding. We describe a case of 20-year old female, who presented with sudden heavy vaginal bleeding and was diagnosed with uterine arterio-venous malformation on post-mortem examination. High index of suspicion is required to make a timely diagnosis for appropriate management and to avoid maternal morbidity and mortality. Key words: Uterine arterio-venous malformations, embolization, dysfunctional uterine bleeding.

Presence of accessory spleen in scrotal sac is an extremely rare condition. It is attributed to splenogonadal fusion which is a rare congenital anomaly. It can be an incidental finding on ultrasonography and during orchiopexy or inguinal hernioplasty or less frequently can present as a scrotal swelling usually in adult life mimicking as testicular tumor. In view of the rarity of this condition, we present two cases highlighting the clinical characteristics of the condition, with a special focus on the signs and findings which might help prevent unnecessary orchiectomies. Keywords: Ectopic spleen, Orchiectomy, Splenogonadal fusion, Testicular mass

Lipoid pneumonia is a rare form of pneumonia which was initially described to be caused by inhalation or aspiration of fatty substances. Certain autopsy studies have reported the incidence to be 1.0-2.5%. Based on the mode of lipid acquisition, it has been classified into endogenous, exogenous or idiopathic types. Almost 50% of the patients with lipoid pneumonia are asymptomatic, and may be discovered by chance during routine chest imaging. In symptomatic patients, the symptoms are non- specific. However, it can produce inflammatory pneumonitis that can progress to irreversible pulmonary fibrosis as seen in our case. We present a case of a 53-year-old deceased male. A piece of one of his lungs was received after autopsy, which appeared normal grossly. There was no history of any illness before death. Microscopy revealed interstitial fibrosis with collection of foamy macrophages in alveolar spaces and cholesterol crystals surrounded by inflammatory reaction including occasional giant cells. The clinical picture and radiologic changes in cases of lipoid pneumonia can mimic bacterial pneumonia and tuberculosis. The occupational history is of extreme importance and should always be investigated.

Metastatic deposits in skull bones from follicular thyroid carcinoma is rare, and metastatic disease in skull being the presenting symptom without obvious thyroid lesion (occult primary) is even rarer. A 60-year-old female patient presented with a mass in the frontal region of the skull. Fine needle aspiration cytology was done which revealed an adenocarcinoma with repeated follicular pattern, reminiscent of follicular neoplasm of thyroid, which on immunocytochemistry revealed positivity for thyroglobulin. Patient was investigated further for primary thyroid malignancy, and imaging revealed a nodule in the left lobe of thyroid. Neuroimaging showed osteolytic lesion involving the cranium.

Langerhans cell histiocytosis (LCH) is a rare cancer involving clonal proliferation of Langerhans cells (LCs) resembling epidermal dendritic cells. It can involve any organ or system. Temporal bone LCH is often confused with ear inflammatory lesions and malignant tumors. Diagnosis is based on clinical, radiological, and pathological findings. The definitive diagnosis is made on biopsy and by immunohistochemical demonstration of CD 1a and or Langerin positivity in the clonally neoplastic cells. The course of LCH is variable from spontaneous regression to repeated recurrences and death. The main form of treatment is chemotherapy. We describe a case of multifocal multisystem LCH in a 4-year-old child who presented with recurrent chronic suppurative otitis media and an external auditory canal polyp.

Verrucous hemangioma is an uncommon capillary or cavernous hemangioma with reactive epidermal changes of hyperkeratosis, acanthosis, and papillomatosis. Lesions are mostly seen at birth or appear during childhood. These growths are usually located on the lower extremities, and involvement is generally unilateral. Diagnosis of this unusual presentation can only be confirmed following histopathology. Surgical excision resulted in a satisfactory functional and cosmetic outcome.

Background: Breast lesions including breast cancer represent a major public health issue worldwide. Fine needle aspiration cytology (FNAC) is established as most sensitive, specific, accurate, safe and cost effective for diagnosing lesions of breast preoperatively and avoiding unnecessary surgical interventions like diagnostic excision or incisional biopsy. The aim of this study is to determine the most common breast lesions diagnosed by FNAC and its histopathological correlation over a two year period. Material and Methods: A total of 1084 cases with palpable breast lesions were subjected to FNAC over a period of two year. A provisional clinical diagnosis was made in each case at the outset. Routine investigations like DLC, TLC, ESR and special investigations like Mammography were done. Air dried and wet fixed (95% alcohol) smears were prepared for Leishman and Papanicolaou or Hematoxylin and Eosin stain respectively. Special stains were used like Ziehl- Neelsen stain and Periodic Acid Schiff (PAS) stain wherever necessary. Diagnosis was made on the basis of cytomorphological features of the lesion. Out of 1084 patients, only 100 patients who were diagnosed with malignancy on FNAC were reviewed with biopsies or postoperatively in our department and were confirmed histopathologically. Results: The study shows that out of 1084 cases, total number of benign lesions were 73.8%, malignant lesions were 22.1%, equivocal cases were 7.5%, cases for suspicious of malignancy were 2.9% and 1.75% cases were inadequate. Maximum number of cases reported as breast carcinoma were seen in age group of 41-50 years (31.3%) and second highest number were seen in 51-60 years (26.3%) with male (88 cases) to female (977 cases) ratio of 0.09:1. Among 800 benign lesions, fibroadenoma was the most significant lesion observed constituting 44.9%, second most common lesion encountered was benign mammary lesion constituting 18.9% followed by inflamed/ acute cystic lesion, (47.5%). Gynaecomastia constituting (35.4%)

Objective: In recent years, during routine examination of bone marrow aspirates, an increased plasma cell percentage has been noted in a good number of cases which included both neoplastic and non-neoplastic diseases. An attempt has been made to observe the spectra of conditions with plasmacytosis in bone marrow.Methods: The present study was conducted in the department of pathology over a period of one year. A total of 114 bone marrow aspirates that showed increased plasma cells (>3.5%) constitute the study material. A detailed relevant clinical examination followed by complete blood count, peripheral smear examination and bone marrow aspiration was done in all cases.Results: There was slight female predominance with male to female ratio of 1:1.1. The majority of patients were in 4th decade. The plasma cell concentration ranged from 5% to 36%. As far as the etiology is concerned, 96 cases (84.2%) were non-neoplastic and 18 cases (15.7%) had neoplastic etiology.Conclusion: Bone marrow plasmacytosis can present as diagnostic dilemma and some time can be challenging to differentiate reactive from neoplastic condition as there is an overlap both in counts and morphology. Each case with plasmacytosis especially in the overlap range requires complete clinical evaluation, individualized investigations and more specific tests like immunoelectrophoresis and bone marrow biopsy with immunohistochemistry to arrive at a final diagnosis for patient management.Key words: Reactive plasmacytosis, bone marrow, multiple myeloma, megaloblastic anaemia, Amaç: Son yıllarda rutin kemik iliği aspiratı incelemelerinde saptanan neoplastik ve non-neoplastik hastalıklarda giderek artan oranlarda plazma hücrelerine rastlanmaktadır. Bu çalışmada kemik iliği aspiratında plazmasitoz saptanan durumların bir spektrumu çıkarılmaya çalışılmıştır.Yöntemler: Sunulan çalışma bir yıllık süre içinde Patoloji Bölümünde gerçekleştirildi. Çalışma materyalini artmış oranda plazma hücresi (>%3,5) gösteren toplam 114 kemik iliği aspiratı oluşturmaktadır. Tüm olgularda ayrıntılı bir klinik muayene ve takiben tam kan sayımı, periferik yayma ve kemik iliği aspirasyonu yapıldı.Bulgular: Erkek / Kadın oranı açısından hafif bir kadın üstünlüğü görüldü (1 / 1,1). Vakaların çoğu 40’lı yaşlarda idi. Plazma hücre yoğunluğu %5-36 arasında değişmekte idi. Etyoloji açısından 96 (%84,2) olguda non-neoplastik, 18 (%15,8) olguda ise neoplastik bir etyoloji saptandı.Sonuç: Kemik iliği plazmasitozu tanısal bir karmaşaya yol açarak, özellikle sayı ve morfolojik görünümlerinde çakışma olan reaktif patolojilerin neoplastik durumlardan ayırt edilmesini bazen zorlaştırabilir. Özellikle çakışma aralıklarındakiler başta olmak üzere, plazmasitozlu her hastada bireyselleştirilmiş araştırmalar ve immunelektroforez ve immunhistokimya ile boyanmış kemik iliği aspiratı incelemesi ile sonuç tanısı konabilir ve hasta yönetimi gerçekleştirilebilir

Aim and Objective: The main aim of this study is to categorize, type, grade of soft tissue tumors & correlate it with Ki-67 proliferative index. Material and Methods: The present study was conducted in the Department of Pathology, PGIMS, Rohtak. The study group comprised of excised 44 cases of STT (soft tissue tumors) specimens. Tumor grade was assigned based on the FNCLCC (Federation Nationale des Centers de Lutte Contre le Cancer) grading system. According to the Ki-67 index the patients were divided into two groups: high index group (>50/10HPF) and low index group (

Background: In recent years basal cell markers (high molecular weight cytokeratin [HMWCK]) and prostate biomarker alpha-methyl acyl-coenzyme A racemase (AMACR) have been used as adjuvant to morphology in diagnostically challenging cases with a very high sensitivity and specificity. This has increased the diagnostic accuracy of prostate cancer worldwide. Materials and Methods: In this prospective study, total of 50 cases including 37 cases of malignant lesions and 13 cases of benign lesions of the prostate were taken. Tumor grade was determined according to Gleason's grading system. AMACR and HMWCK expressions were determined by immunohistochemical staining. The obtained results were analyzed and evaluated using Chi-square statistical test (SPSS version 20). Results: AMACR was not expressed in any of the 13 cases of benign lesions of the prostate while in malignant lesions of prostate it was expressed in 33 of 37 (89.18%) cases. All 4 (100%) cases of well-differentiated carcinoma were positive for AMACR expression. 21 of 25 (84%) moderately differentiated and all 10 (100%) cases of poorly differentiated tumors were positive for AMACR. There was statistically significant difference in expression of AMACR between benign and malignant lesions of the prostate, indicated byP = 0.001. In benign lesions, HMWCK was expressed in all the 13 (100%) cases while in malignant lesions of prostate it was not expressed in any of the (0%) case. All 13 benign lesions were positive for HMWCK only. AMACR expression was not seen in any of the benign lesion. Out of 37 malignant cases, 4 cases were negative for both, 33 cases were positive only for AMACR, but no case was positive only for HMWCK. Conclusions: As an adjunct to biopsy, AMACR and HMWCK have value for resolving diagnostically challenging cases.

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 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.

Background: Head and neck squamous cell carcinoma (HNSCC) is the sixth-most common malignancy worldwide. Despite advances in radiotherapy and surgical treatment, survival rates have not changed significantly in the last 40 years. Molecular markers are currently being identified that can determine prognosis preoperatively by routine tumor biopsy, lead- ing to improved management of HNSCC patients. Aim: The aim of the present study was to demonstrate the expression of p53 and bcl2 proteins in squamous cell carcinoma of head and neck (HNSCC) and to correlate the expression of p53 and bcl2 with clinical staging (AJCC) and WHO histological grading of SCC. Materials and methods: The study population comprised 50 cases of HNSCC. Tissue sections from these cases were subjected to hematoxylin and eosin (H and E) and immunohistochemical (IHC) staining using p53 and bcl2, and a comparative analysis of the results was performed. Cases of colon carcinoma and benign lymphoid hyperplasia were used as positive controls for p53 and bcl2, respectively. Results: Positivity for p53 was recorded in 30 cases (30/50), while positivity for bcl2 was recorded in 44 cases (44/50). Positivity for p53+/bcl2+ coexpression was seen in 28 cases (28/50). The frequency of p53 expression was associated with tumor histologic grade (p=0.02), increasing lymph node involvement (p=0.01), and clinical stage (p=0.038). The frequency of bcl2 expression was associated with histological grade (p=0.02) and increasing lymph node involvement (p=0.028), but not with clinical stage (p=0.242). Moreover, the combined p53+/bcl2+ expression was significantly associated with histo- logical grade (p=0.02) and lymph node involvement (p=0.01). Conclusion: Study of p53 and bcl2 expression may provide clinicians with more exact information in order to evaluate tumor aggressiveness and survival rates. [Arch Clin Exp Surg 2016; 5(3.000): 160-168]

Marjolin's ulcers are malignancies that arise in chronic venous ulcers, scars, burns, long-standing wounds or sinuses. The most common type of carcinoma arising in the Marjolin's ulcer is squamous cell carcinoma (SCC), followed by basal cell carcinoma. Verrucous SCC (VSCC) comprises about 3% of all SCCs. It is most commonly diagnosed in the oral cavity, and the incidence is approximately one in a million/year. To the best of our knowledge, malignancy arising in a postnephrectomy sinus has never been described before. We herein report a case of VSCC in a sinus developed after nephrectomy done for renal stones.

Familial adenomatous polyposis (FAP) is an autosomal dominant condition that results in development of the large number of colorectal, and eventually, small intestinal or even gastric adenomas at an early age (late childhood to early adulthood). Extragonadal yolk sac tumors (YSTs) of the gastrointestinal tract are extremely rare neoplasms. Their greater rarity compared with other extragonadal YSTs suggests that different pathogenetic mechanisms could be involved according to the site of origin. Recent epigenetic studies suggest the involvement of some tumor suppressor genes, including the adenomatous polyposis coli gene in testicular YST. No case has so far been described in setting of FAP. Hereby, we describe a case of extragonadal germ cell tumor arising in colectomy stump of a patient with FAP.

Sebaceous carcinoma of the ocular adnexa is a malignant neoplasm which has aggressive local behavior and can metastasize to regional lymph nodes and distant organs. It is a malignant neoplasm known to masquerade as other benign and less malignant lesions, resulting in delay in diagnosis and relatively high morbidity and mortality. Aspiration cytological features of this neoplasm have not been well characterized in the literature. We report a case of this tumor diagnosed on fine needle aspiration. Clinically, a diagnosis of chalazion was made and fine needle aspiration cytology (FNAC) was performed. Cytological diagnosis of a malignant tumor with closest resemblance to sebaceous carcinoma was suggested which was confirmed on histopathology. Eyelid reconstruction was done after histopathological confirmation of tumor-free margins. The article highlights the role of FNAC in early diagnosis and subsequent appropriate surgical management of eyelid sebaceous gland carcinoma to prevent recurrence and metastasis.

Cysticercosis is a condition that occurs when man is infected with larvae of Taenia solium. Oral cysticercosis is a rare event, and it represents difficulty in clinical diagnosis. A case of oral cysticercosis in 11 year old girl is presented which complained of painless swelling for 6 months. A FNAC was performed which revealed bluish pink fibrillary material and interspersed nuclei and fragments of wall of larvae. Patient was treated with antihelminthic.

Introduction The dissecting aneurysm of renal artery is a form of renal artery occlusive disease that is infrequently recognized in the literature. However, when encountered, it is of great clinical significance because symptoms related to aneurysm are rarely seen and there is risk of its rupture. Case Presentation The present case was a 30 year old Indian male, who presented with recurrent episodes of pain mimicking renal colic, which turned out to be a ruptured dissecting aneurysm of renal artery on exploration. The patient could not be salvaged due to delay in the diagnosis. Conclusion This report highlights that rupture of renal artery aneurysm is a rare but potentially lethal clinical entity and should be considered as one of the differential diagnosis in patients with severe and persistent renal colicky type of pain in the absence of obvious findings on routine investigations.

Primary intraosseous meningioma of the skull is an uncommon lesion often confused preoperatively with a primary bone tumor of the skull. We report this rare tumor in a 19-year-old male who was radiographically diagnosed as osteoid osteoma.

Malignant tumours affecting the eyelid include basal cell carcinoma (85% to 95%), squamous cell carcinoma (approximately 5%), sebaceous carcinoma (1% to 5%), and malignant melanoma (1%). Non-Hodgkin’s lymphoma of the eyelid is rare. This report is of an 80-year-old woman who presented with diffuse left upper eyelid swelling, clinically suspected to be a haemangioma. Rare diseases should be considered in differential diagnoses because they have the potential for rapid systemic involvement and may need treatment that is different from that of other common diseases at the same site.