Search

Male breast cancer (MBC) is an uncommon malignancy. The scarcity of cases has reduced the focus of research in this area as compared with female breast cancer. The incidence of breast cancer in males is slowly rising and it becomes important to study the biology of this uncommon illness. Aim of the present work was to study the clinico-pathological behaviour of male breast cancer at a cancer research institute in India. 18 cases of MBC were identified out of 1752 cases of breast cancer registered during a 10 year period. Clinical parameters and histopathological data were analysed. MBC comprised of 1.03 % of total breast cancer cases. Median age of presentation was 60 years. Most of the patients presented to us in advanced stage. Aggressive pattern of disease was recognised with high node positivity, more perineural spread and lymphovascular invasion. Most of the cases were positive for hormone receptors. Breast cancer is seen at a relatively early age in Indian males. Disease is aggressive in nature with high hormone receptor positivity.

During 2012-13, we diagnosed 4 patients with extensive skeletal tuberculosis (TB) who were referred to us as cases of bony metastasis with unknown primary. Radiological investigations done outside favoured a diagnosis of disseminated malignancy. Positron emission tomography/computed tomography (PET/CT) scan performed in our institute for localization of primary lesion also suggested metastatic disease. There was no evidence of malignancy on histo-pathological examination (HPE) of the involved sites. The diagnosis of TB was established on characteristics HPE. This article highlights the diagnostic dilemma of PET/CT in cases of TB versus malignancy and the importance of HPE for reaching an accurate diagnosis.

Yokenella regensburgei is an opportunistic human pathogen of the Enterobacteriaceae family rarely reported to cause human infections. Here, we present a case report of Y. regensburgei bacteraemia from India clinically resembling enteric fever in an apparently immunocompetent paediatric patient.

Objective: To describe a unique case of secondary gliosarcoma (SGS) with widespread extra-cranial metastases that developed more than 5 years after the initial diagnosis of glioblastoma multiforme (GBM). This interval is the longest among the cases reported to date., Methods: A PUBMED search using the key words "secondary gliosarcoma" and "extra-cranial metastases" was performed followed by a review of cited literature., Results: Including our report, we found 44 cases of SGS, of which only 5 developed extra-cranial metastases., Conclusion: SGS with extra-cranial metastases is extremely rare. Of previously reported cases, the longest survival was 2 months after the diagnosis of SGS. The present case had a survival of 6.5 months. Our case highlights the importance of screening for extra-cranial metastases in SGS. The optimal treatment of SGS is not known and strategies based on GBM and sarcoma treatments have been employed with limited success. A combination of treatment modalities may extend survival as in the present report; however the prognosis remains poor., (Copyright © 2012 Elsevier B.V. All rights reserved.)

It is believed that antiviral prophylaxis decreases the incidence of cytomegalovirus (CMV) reactivation and disease. There are few data regarding weekly assays for CMV DNA after transplantation and the subsequent management of CMV. Here we report a cohort of living related liver transplantation (LRLT) patients who were treated for invasive CMV disease or for CMV infections if they were receiving steroids for rejection. Patients who underwent liver transplantation at our center between September 2006 and August 2010 and were recipient-positive/donor-positive (R(+) /D(+) ) were prospectively included. Patients were tested for CMV DNA 3 weeks after transplantation. CMV DNA-positive patients underwent weekly DNA monitoring until there were 2 consecutive negative reports. Those who developed CMV disease or had rising DNA titers while they were on treatment for rejection were treated. A Cox regression analysis was performed for factors predicting survival. Two hundred sixty-six of the 306 R(+) /D(+) patients were CMV DNA-negative 3 weeks after transplantation, and 40 had detectable DNA. One of the DNA-negative patients developed CMV disease after treatment for rejection with methylprednisolone. Thirty patients had <500 copies/mL, and 10 had ≥500 copies/mL. Two of the 30 patients with DNA levels < 500 copies/mL developed CMV disease. Six of the 10 patients with DNA levels ≥500 copies/mL developed disease. CMV disease occurred in 9 of the 306 patients (2.9%). One patient received treatment for a rise in DNA titers while he was receiving steroids. There was a significant correlation between steroid administration for acute cellular rejection (ACR) and CMV reactivation (P = 0.003) and disease (P = 0.002). A multivariate analysis showed that CMV reactivation/disease did not predict survival. There was no difference in survival between CMV DNA-positive patients and CMV DNA-negative patients (P = 0.68). In conclusion, CMV reactivation is common after LRLT (13%), but the disease is rare (2.9%) without prophylaxis in CMV immunoglobulin G-positive recipients. The administration of steroids for ACR strongly correlates with CMV reactivation and disease. CMV reactivation and disease did not affect survival in our patient cohort., (Copyright © 2012 American Association for the Study of Liver Diseases.)

Mantle cell lymphoma (MCL) is considered an aggressive and incurable B-cell malignancy despite current available treatments that include the incorporation of rituximab, bortezomib, high-dose cytarabine, and for those eligible, high dose chemotherapy and autologous bone marrow transplant (HDC-ASCT). Patients with relapsed/refractory MCL represent a challenge for the treating physician stressing the need to develop therapeutic agents. Lenalidomide, a novel inmmunomodulatory drug (IMiD), is a promising therapeutic strategy for patients with relapsed/refractory B-cell lymphoma. Biologically, the mechanisms responsible for lenalidomide activity are yet to be clearly defined. Based on pre-clinical models and early correlative studies conducted parallel to clinical trials, lenalidomide has been found to enhance NK-cell and T-cell activity against tumor cells, alter the balance of pro- and anti-inflammatory cytokines in the tumor bed, inhibit angiogenesis, and to a lesser degree, induce cell cycle arrest and apoptosis in cancer cells. Together, all these biological effects appear to play a role in the activity observed in lymphoma patients treated with lenalidomide. Given the effect in NK- and T-cell function, lenalidomide is an alternative strategy to enhance the anti-tumor activity of monoclonal antibodies (mAbs). Clinical responses have been observed in patients with relapsed/refractory chronic lymphocytic leukemia (CLL), follicular lymphoma, small lymphocytic lymphoma, diffuse large B-cell lymphoma (DLBCL), and MCL. The favorable toxicity profile and route of administration made the use of lenalidomide an attractive therapy for certain types of patients (i.e. elderly, chemotherapy unfit, etc.). The erratic but serious incidence of tumor lysis syndrome and/or tumor flare reactions provides challenges in the incorporation of lenalidomide in the management of previously untreated lymphoma patients with bulky adenopathy. Early studies evaluating the efficacy and toxicity of lenalidomide in combination with steroids or rituximab/bendamustine in MCL are promising and warrant further study. In addition, the evaluation of lenalidomide in the maintenance setting (i.e. post HDC-ASCT) or in combination with other target specific agents (i.e. proteasome inhibitors) in MCL is being addressed in ongoing clinical trials. We provide a general overview of the clinical development of lenalidomide in MCL. Future translational and clinical studies will further define the role of lenalidomide in the management of de novo or relapsed/refractory MCL and may assist in the identification of subset of MCL patients most likely to gain clinical benefit from this exiting agent., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

The aim of this study was to evaluate the feasibility of splitting each head of the gastrocnemius muscle into two segments. This prospective study was conducted on 35 fresh cadavers with injection of radio-opaque contrast material in the popliteal artery. Seventy medial gastrocnemius and 70 lateral gastrocnemius muscle specimens were obtained. Gastrocnemius intramuscular arterial anatomy was analysed by using the digital X-ray technique. The most common vascular pattern found in this study was both bellies supplied by individual sural arteries, which shows distal bifurcation. The medial sural artery always showed bifurcation in the medial gastrocnemius muscle in both lower limbs, whereas this bifurcation of the lateral sural artery was present in only 87% cases and 13% of cases showed a single lateral sural artery without bifurcation in the lateral gastrocnemius muscle. The mean pedicle length of the medial sural artery in the right lower limb was 2.1 cm, and in left lower limb 2.3 cm. The mean pedicle length of the lateral sural artery in the right lower limb was 2.44 cm and in the left lower limb 3.21 cm. The segmental vascular pattern of the medial belly of the gastrocnemius is constant, and, thus, it can be divided safely for coverage of multiple wound defects around the knee joint. The short length of the median sural artery allows for high division of the medial gastrocnemius muscle belly. The segmental vascular anatomy is not constant in the lateral belly of the gastrocnemius muscle and, hence, division of the lateral belly is not advocated without prior preoperative colour Doppler., (Copyright © 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: Ovarian cancer is the second most common cancer among women and the leading cause of death among gynecologic malignancies. In recent years, infrared (IR) spectroscopy has gained attention as a simple and inexpensive method for the biomedical study of several diseases. In the present study infrared spectra of normal and malignant ovarian tissues were recorded in the 650 cm-1 to 4000 cm-1 region., Methods: Post surgical tissue samples were taken from the normal and tumor sections of the tissue. Fourier Transform Infrared (FTIR) data on twelve cases of ovarian cancer with different grades of malignancy from patients of different age groups were analyzed., Results: Significant spectral differences between the normal and the ovarian cancerous tissues were observed. In particular changes in frequency and intensity in the spectral region of protein, nucleic acid and lipid vibrational modes were observed. It was evident that the sample-to-sample or patient-to-patient variations were small and the spectral differences between normal and diseased tissues were reproducible., Conclusion: The measured spectroscopic features, which are the spectroscopic fingerprints of the tissues, provided the important differentiating information about the malignant and normal tissues. The findings of this study demonstrate the possible use of infrared spectroscopy in differentiating normal and malignant ovarian tissues.

The apolipoprotein A1 gene polymorphism (G-75A and C+83T) was studied in 100 subjects (50 patients diagnosed with myocardial infarction and 50 healthy subjects). Serum apolipoprotein (apo) A1 and apo B levels were estimated immunoturbidometrically. Extracted DNA from blood was amplified by polymerase chain reaction, digested with MspI restriction enzyme, run on 8% polyacrylamide gel, and restriction fragment length polymorphism was studied by using a gel documentation system. Serum (mean +/- SD) apo A1 levels were significantly higher in control subjects than the study group (100.80 +/- 7.06 mg/dL [1.0 +/- 0.07 g/L] and 72.56 +/- 9.86 mg/dL [0.73 +/- 0.1 g/L], respectively; P < .0001), whereas apo B levels were significantly lower (72.12 +/- 11.32 mg/dL [0.7 +/- 0.1 g/L] and 97.45 +/- 9.04 mg/dL [1.0 +/- 0.09 g/L], respectively; P < .0001). The G allele frequency at the -75-base-pair (bp) site was higher in the study group (79%) compared with the control group (58%). The T allele frequency at the +83-bp site was higher in the study group (56%) than in the control group (32%). G at -75 bp upstream from the start of transcription and T at +83 bp in the first intron may be susceptibility alleles for myocardial infarction.

Background & Objective: Association of Epstein-Barr virus (EBV) with Hodgkin lymphoma (HL) is particularly high in low-income countries, and resistance to apoptosis might play a role in pathogenesis and survival. Data from previous studies are not consistent, and none is available in children. Thus this study was undertaken on Indian children with classical Hodgkin lymphoma to assess the significance of bcl-2, bak and p53 expression, and apoptotic index in relation with EBV status and treatment outcome with chemotherapy alone., Methods: Children (age<15 yr) with classical HL (n=143) were included in the study. Bcl-2, bak, p53, Ki67 and latent membrane protein-1 (LMP1) were detected by immunohistochemistry in pre-treatment lymph node biopsies. Apoptotic index was assessed by TdT-dUTP nick-end labelling (TUNEL)., Results: Bcl-2, bak, p53 were expressed above positivity threshold in 83.3, 94.0 and 7.1 per cent of the cases respectively. More than 10 per cent of apoptotic tumour cells were seen in 60.4 per cent of the cases. 131 (91.6%) cases were EBV associated. EBV-positive cases had a significantly lower mean bak expression (p=0.001) and a lower apoptotic index, without higher proliferation index. Advanced stage showed a borderline association with bcl-2 expression in >25 per cent of tumour cells and p53 negative tumours. In univariate analysis, p53 positive cases, which were significantly associated with B symptoms, had a poorer overall survival (P=0.03) while low proliferation index was associated with poorer failure-free survival. Neither EBV status nor any of the apoptotic parameters studied showed independent association with survival., Interpretation & Conclusion: EBV detection in children with classical Hodgkin lymphoma was associated with significant lower bak expression and with lower spontaneous apoptosis of H-RS cells suggesting that EBV-LMP1 might downregulate bak pro-apoptotic protein. this needs to be substantiated further.

Background: We assessed the impact of clinico-pathological meetings on the diagnosis and management of patients with ovarian cancer., Methods: Between January 2005 and December 2006, about 400 patients of suspected or confirmed ovarian cancer were evaluated in the 'Gynaecology Tumour Clinic'. Of these, 108 cases were referred for discussion in the weekly clinico-pathology meeting for various indications. These cases were retrospectively analysed regarding their initial clinical and pathological diagnosis, the indication for referring the case for discussion in the meeting and the impact this had on the overall management. Alterations in diagnosis, which impacted management, were classified as 'major changes' and those, which did not, were called 'minor changes'., Results: Ninety-one of the 108 cases discussed were available for analysis; 75.8% of cases were initially diagnosed as epithelial ovarian cancers. In 48 of 91 cases (52%), there was an alteration in the diagnosis as a direct result of discussion in the meeting, mainly after clarifications regarding histological grading in 34 cases. Of the remaining 14 cases, 3 had a change in histopathological diagnosis; 2 cases, which were initially labelled as undifferentiated tumours, had their diagnosis clarified; and in the remaining 9 cases, in which the primary site was not known, a possible primary site could be assigned (with the help of clinical, radiological and pathological inputs). Among the 14 cases with alterations other than grading, the change was contributed by slide review alone in 7 cases and in the rest by a combination of slide review and clinical inputs. As a direct outcome of the meeting, 20 of 91 cases (22%) had their management plan modified (major change)., Conclusion: The practice of conducting weekly clinicopathological meetings has a major impact on the management of cases of ovarian cancer.

Background: This study was conducted to assess the clinical and prognostic significance of lack of CD15 expression, proliferative index (PI), and expression of tumor suppressor protein p53 in pediatric classical Hodgkin lymphoma (CHL)., Procedure: Pre-treatment lymph node (LN) biopsies were studied by immunohistochemistry for immunophenotyping of the lymphoma and with Ki-67 (PI) and p53 antibodies. Expression of CD15 antigen on the Hodgkin and Reed-Sternberg (H-RS) cells, proliferation, and apoptosis parameters were correlated with clinical stage, response to chemotherapy alone, overall (OS) and failure-free survival (FFS)., Results: One hundred and twenty-one children with CHL were studied. Expression of Ki-67 and p53 in H-RS cells was seen in 100% and 89.9% of the cases, respectively. Loss of CD15 expression, seen in 12 (9.9%) cases, was significantly associated with p53 negativity and was an independent prognostic factor for poor OS and poor FFS. PI

Fine needle aspiration cytology (FNAC) enjoys popularity among clinicians worldwide, as a first line of investigation in all patients with lymphadenopathy and is preferred over biopsy because of its minimally invasive nature and cost-effectiveness. Although non-Hodgkin's lymphomas (NHL) are conventionally diagnosed and graded on biopsy specimens, it may be useful to be able to not only diagnose but also grade these cases on FNAC smears. The WHO and REAL classifications forming the basis of treatment in some centres rely on clinical features, immunocytochemistry and cytogenetics, which are beyond reach of most centres in the developing countries. This study therefore is aimed at diagnosing and grading NHLs on morphological parameters. The cytologic grading accuracy is compared with the histologic grades assigned according to the International Working Formulation (IWF) system which relies solely on morphological features, most important of which is cell size. Ninety five cases were retrieved over a 3 year period (May 2000 to April 2003). These were (i) cases where a cytological diagnosis of NHL or suspicious of NHL was made and corresponding histological sections available and (ii) cases where a diagnosis of NHL was made in histology and corresponding FNAC smears were available irrespective of the cytological diagnosis. The diagnostic accuracy of FNAC for NHLs was determined using histology as the gold standard. Cases were also graded on FNAC smears using a three tier grading system based upon cell size into low, intermediate and high grades. Cytologically assigned grades were correlated with the corresponding histological grades (IWF) to determine grading accuracy. An accurate diagnosis of NHL was thus possible in 67/95 (70.5%) cases. Overall accurate grading was seen in 65/95 (68%) cases using cytological criteria. Accurate cytologic grading was possible in 14/15 (93.33%) low grade, 11/18 (61.11%) intermediate and 40/62 (64.5%) high grade non Hodgkin's lymphomas. Kappa statistics revealed a very good agreement between cytological and histological grades for low grade NHL. The kappa scores for intermediate and high grade NHLs indicated moderate agreement. Using the two-tier system grading the kappa value for high grade lymphomas improved to 0.72, indicating good concordance. This study highlights the utility of FNAC as a morphological tool for diagnosing and grading NHLs in a significant number of cases. This modality may assist clinicians in management of cases of NHLs, especially in centres working within the constraints of limited availability or non availability of ancillary techniques.

We studied the prognostic value of parameters of angiogenesis on bone marrow biopsies in newly diagnosed multiple myeloma (MM) patients. Angiogenesis parameters studied were the microvessel count done manually on light microscopy (MVD-A), microvessel count done by using computerized image analyzer (MVD-B), and total vascular area (TVA) measured by computerized image analyzer. One hundred ten newly diagnosed cases of MM treated at Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, were analyzed with respect to clinical features, laboratory findings, histological features, angiogenesis parameters, and responses to the treatment on follow-up. Twenty age- and sex-matched controls were studied for comparing with angiogenesis of the test cases. Bone marrow microvessels were examined using immunohistochemical staining for CD34. MVD-A (range 4.9-85.2; mean 28.2; SD 19.4), MVD-B (range 2.0-26.9; mean 11.7; SD 5.9), and TVA measured in percentage (range 0.1-17.1; mean 2.4; SD 2.5) were measured for test cases (n = 110). Grading of angiogenesis parameters of the test cases were done; such that angiogenesis parameters of controls (taken as baseline) were grade I. There was a statistically highly significant correlation between (MVD-A vs MVD-B, pcc = 0.92; MVD-A vs TVA, pcc = 0.78; MVD-B vs TVA, pcc = 0.76). The myeloma cases had significantly higher angiogenesis parameters when compared with controls (Kruskall-Wallis test, P < 0.001). "Complete responders" (n = 38/110) had significant lower angiogenesis (Mann-Whitney U test, P < 0.001) than "nonresponders" (n = 72/110). On treatment follow-up "rapid disease progressors" had the highest levels of angiogenesis (mean rank for MVD-A = 84.7, MVD-B = 82.1, and TVA = 81.1). On multivariate (logistic regression) analysis, factors found to have independent prognostic significance in complete responders (adjusted odd ratio (95% CI, P value)] were: (a) MVD-B grade I [0.134 (0.10-0.16, P < 0.001)], (b) clinical substage A [0.163 (0.12-0.19, P = 0.008)], (c) Bartl's histological stage II & I [0.262 (0.2-0.32, P = 0.021)], (d) MVD-A grade I [0.28 (0.22-0.36, P = 0.03)], (e) beta2 microglobulin levels less than 3,400 ng/dl [0.31 (0.23-0.42, P = 0.04)]. Kaplan-Meier survival analysis for myeloma-related death (n = 16) shows a mean survival time (in months) of 24.75; SE = 3; 95% CI = 21-28. We conclude that MVD (particularly MVD-B) is a very good predictor for the complete response in patients of MM and should be done routinely on bone marrow biopsies., ((c) 2006 Wiley-Liss, Inc.)

Background: To assess the efficacy of chemotherapy alone, using four cycles of COPP alternating with four cycles of ABVD in all stages of childhood Hodgkin's disease (HD)., Procedure: Between January 1991 and February 2001, 148 previously untreated patients were investigated, treated, and analyzed for remission and survival., Results: There were 134 boys and 14 girls with a median age of 8 years, 75% were less than 10 years old. 63.5% had advanced stage disease (IIB-IV). B symptoms were present in 54.4% of cases; bulky mediastinal mass in 18 cases (12.2%); spleen and bone marrow involvement in 22 (14.9%) and four cases (2.7%), respectively. Mixed cellularity (MC) subtype was found in 86.0%. Response to treatment was evaluated in 133 patients: complete remission (CR) was achieved in 121 patients (91.0%), partial remission (PR) in seven (5.3%), progression occurred in two (1.5%), and three (2.3%) died on therapy. Four patients with mediastinal residual disease were given additional involved field radiotherapy. Out of 111 patients analyzable, five (4.5%) have relapsed 6-30 months after completing chemotherapy, and were treated with additional cycles of ABVD and low-dose involved field radiotherapy. The 5-year actuarial overall survival (OS) and event-free survival (EFS) are 91.5 and 87.9%, respectively. Advanced stage, B symptoms, anemia, spleen, and marrow involvement were adverse prognostic factors for survival., Conclusions: Chemotherapy alone with alternating COPP/ABVD, without additional radiotherapy, provides high rates of durable remission and is an effective therapy in childhood HD, even in case of large mediastinal mass and peripheral or abdominal bulky disease.

Objectives: Spleen involvement in childhood Hodgkin disease (HD) has not been described extensively. The authors' purpose was to study the clinicoradiologic features and prognostic significance of splenomegaly and that of splenic involvement in childhood HD., Methods: One hundred forty-one children presenting with HD between January 1991 and February 2001 and treated with chemotherapy alone (4 COPP/4 ABVD) were included in the study. Radiotherapy was given in four patients with residual mediastinal disease. Patients were staged clinically and assessed for splenic deposits by computed tomography, ultrasonography, or both., Results: Splenic involvement was seen in 22 children (15.6%). On univariate analysis, spleen deposits were significantly correlated with constitutional symptoms (P = 0.02), splenomegaly on physical examination (P < 0.001), involvement of three or more lymph node areas (P = 0.006), involvement of subdiaphragmatic lymph nodes (P = 0.01), mediastinal involvement (P = 0.001), and bulky disease (P = 0.005). Multivariate analysis retained enlarged spleen, involvement of three or more lymph node areas, and bulky disease as significant risk factors for spleen involvement. Relapse occurred significantly more in children with splenic involvement (P = 0.04) and in those with splenomegaly (P = 0.04). Presence of splenic deposits was an adverse prognostic factor for 5-year event-free survival (67.5% vs. 93.0%, P = 0.01)., Conclusions: Enlarged spleen, involvement of three or more lymph node areas, and bulky disease are predictable risk factors for HD splenic deposits. Splenic involvement on computed tomography scan or ultrasonography is significantly associated with relapse and contributes to a poorer outcome of HD in children treated with chemotherapy alone.

Recent studies have shown that quantification of silver-stained nucleolar organizer region associated proteins (AgNORs) is correlated with ploidy and proliferative activity in several neoplasms. The prognostic value of this marker, however, has not been well defined in epithelial ovarian carcinomas (EOCs). We studied 84 cases of EOCs in an attempt to assess the potential prognostic significance of AgNORs and to compare the results with other prognostic factors in EOCs. Clinical, operative and treatment details, and follow-up data were recorded for each case. In univariate analysis, a highly significant correlation of AgNOR count with clinical stage (p < 0.01), histologic grade (p < 0.05), response to chemotherapy (p < 0.05), and biologic behavior (p < 0.01) was found. High AgNOR counts were observed in late stage (III and IV) tumors, grade 3 carcinomas, tumors in patients with partial response to chemotherapy, progressive disease, recurrence, or death from tumor. In multivariate analysis, AgNOR count at cut off 3.5 was found to be the third prognostic variable after response to therapy and stage. These observations suggest that AgNOR count holds promise for prediction of tumor aggressiveness in EOCs. However, its role as an independent prognostic variable of patient survival remains questionable.

Objective: To evaluate the role of fine needle aspiration cytology (FNAC) in the diagnosis of lymphoproliferative disease (LPD) of the breast., Study Design: Over a period of 20 years (January 1982-December 2001), 13 diagnosed and/or suspected cases of LPD of the breast on FNAC were retrieved and reviewed from the files of the Cytology Laboratory, Department of Pathology, All India Institute of Medical Sciences. For each case, both May-Grünwald-Giemsa- and Papanicolaou-stained smears were reviewed along with hematoxylin and eosin-stained tissue sections and immunohistochemistry, when available., Results: Of the 13 cases, 1 aspirate was from a male breast and the rest were from female. Only 12 cases with documented histology were included in the study. Five of the 12 cases were diagnosed on FNAC as high grade lymphoma, 2 as low grade lymphoma, 2 as poorly differentiated malignant tumor/lymphoma, and 1 each as Hodgkin's lymphoma, acute myeloid leukemia (AML) deposit and immature lymphoid cells, ?leukemia/lymphoma deposit. The tumors manifested mostly as an unilateral mass (10 cases), with 2 cases presenting with bilateral breast lumps. The lymph nodes were involved in 8 cases. Histologically, 2 of the 12 cases were poorly differentiated malignant tumors. Of the remaining 10 cases, 8 were documented as non-Hodgkin's lymphoma and 1 each as Hodgkin's lymphoma, mixed cellularity and AML., Conclusion: FNAC is an inexpensive but highly useful diagnostic tool to distinguish between primary lymphoma and carcinoma of the breast. This helps with clinical management in avoiding unnecessary surgical procedures.

Background: Mechlorethamine, vincristine, procarbazine, prednisolone (MOPP) and doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) are well established first-line chemotherapy protocols for the treatment of Hodgkin's disease. The aim of this study was to try a new combination of drugs that individually have a proven efficacy in Hodgkin's disease but have less incidence of severe nausea, vomiting, pulmonary toxicity and sterility., Methods: This prospective, single-arm study enrolled 66 newly diagnosed, previously untreated patients of Hodgkin's disease with stages IA (bulky)-IVB disease. They were given 6-8 courses of etoposide, vinblastine, doxorubicin and prednisolone (EVAP) as first-line chemotherapy between January 1992 and December 1997. Radiotherapy (RT) was given to the involved fields of those patients who had bulky (> or = 10 cm) stages I or II disease at presentation. The end-points were (i) complete and overall response; (ii) disease-free and overall survival; and (iii) toxicity., Results: Complete response was seen in 78.8% and partial response in 12.2% of patients; the overall response rate was 91%. The median follow up was 48 months. The 5-year overall and disease-free survivals were 72% and 62%, respectively. There were 3 episodes of grade IV neutropenia requiring hospitalization. One patient developed avascular necrosis of the femur. There were 2 deaths during treatment, one due to chemotoxicity, and another due to progressive disease., Conclusion: The overall and complete responses were fractionally inferior to the recently published hybrid MOPP/ ABV combination and that of ABVD chemotherapy. The advantages of the EVAP combination are absence of pulmonary toxicity, markedly lower incidence of sterility and nausea and vomiting. EVAP is an attractive option and a randomized trial is warranted to assess its efficacy against established protocols.

Fertility preserving radical cystectomy has been reported in young males with leiomyosarcoma and transitional cell carcinoma but not in females. We present a case of 19-year-old lady with mesenchymal tumour of urinary bladder with myogenic differentiation who was managed with fertility preserving radical cystectomy. As the patient was just 19-year-old a consensus was made to preserve the internal genitalia (both the ovaries and uterus) in order to restore the fertility. Immunohistochemistry was compatible with mesenchymal tumour with myogenic differentiation. Adjuvant chemotherapy (Ifosfamide, CDDP and Etocid) was given. Patient is doing well at a follow-up of 6 months.

Primary malignant mesenchymal tumours of the greater omentum are rare. We report a 40-year old man with a painless abdominal lump of two months duration. At laparotomy, the mass was found to be arising from the greater omentum. A near-total omentectomy was done. Histological examination of the resected tumour revealed features consistent with malignant fibrous histiocytoma.

Objective: In order to study the clinical profile of children presenting with superior vena cava syndrome (SVCS), case records of all children presenting with SVCS over a 10-year period were retrospectively analyzed., Methods: Twenty one children (20 males and 1 female) with a median age of 10.0 years (range 5.0 to 12.0 years) were detected to have an underlying hematological malignancy. T-cell acute lymphoblastic leukemia accounted for a major share (57%) in the underlying etiology; 33% of the subjects had non-Hodgkin's lymphoma (T-cell lymphoblastic lymphoma)., Result: No Patient required radiotherapy or urgent thoracotomy. Among survivors (n=11), who were alive and well at the time of writing this report, the median follow-up was 6.5 years, (range 0.5-9.6 years). T-cell ALL and lymphoblastic lymphoma are common underlying causes of SVCS in Indian children., Conclusion: The value of diagnostic interventions performed under local anaesthesia and prebiopsy corticosteroids usage was found to be reassuring since long-term survival without disease is achievable.

Silver stained Nucleolar Organiser Region (AgNOR) counting is a well established method of estimating the proliferative activity of a tumour. Their utility in prognostication in Non Hodgkin's Lymphoma (NHL) has not been fully investigated. We analysed hundred cases of NHL, all of which had a minimum of two and a half years of follow up, using histology by International Working Formulation (IWF) and their AgNOR scores. We found the IWF grading to have a good correlation with the outcome. The two and a half year survival for low grade NHL was 90 percent, for intermediate grade NHL was 47 percent and for high grade NHL was 30 percent. AgNOR scores correlated well with IWF grading and classification, with average AgNOR score of 1.82 (SD 0.34) in low grade NHL; 4.47 (SD 2.25) in intermediate grade NHL and 7.07 (SD 4.40) in high grade NHL. Over histology, AgNOR counting yielded additional prognostic information only in the diffuse small cleaved cell NHL (DSC), where finely dispersed NORs were seen. Of the 22 case of DSC included, 11 cases with AgNOR scores less than three had a much better outcome with 75 percent survival at two and a half years. Cases of DSC with AgNOR scores greater than three had a significantly worse outcome with only 25 percent survival at two and a half years (p=0.0103). Such sub-stratification could not be done in any other catergory of NHL using AgNOR scores. Thus, counting of AgNORs in lymphomas with finely dispersed NORs as in DSC is of prognostic value.

We report a rare association of carcinoma and tuberculosis of the stomach. It is difficult to explain the simultaneous occurrence or a causal relationship of the two diseases.

This prospective study was undertaken to study the occurrence of histologic chorioamnionitis and determine its association with prematurity; and to assess whether colonization of the genital tract of pregnant women by genital mycoplasmas or Chlamydia trachomatis is a risk factor for histologic chorioamnionitis. A total of 268 women with singleton pregnancies of over 26 weeks gestation were subjected to high vaginal cultures of genital mycoplasmas and endocervical specimens for chlamydia antigen. Placental histopathology was performed on multiple sections. Histologic chorioamnionitis was documented in 22.4 per cent (60/208) placentae. Genital tract colonization with Ureaplasma urealyticum or C. trachomatis was not a risk factor for histologic chorioamnionitis. Neonates born in association with histologic chorioamnionitis had a mean birth weight 111 g lower than those born without this lesion (2626.9 +/- 702 g vs 2737.8 +/- 500 g, NS). The relative risk (95% confidence interval) of prematurity in the presence of histologic chorioamnionitis was 1.49 (0.87-2.53). Analysis of linear trend in proportions for prevalence of histologic chorioamnionitis with decreasing gestation showed a significant association (P = 0.047, 1-tail). These results taken together suggest that histologic chorioamnionitis may be a risk factor of prematurity, but of only a modest magnitude.

Background: The prognosis of patients with Hodgkin's disease has improved significantly over the past two decades, primarily as a result of the development of curative combination chemotherapy. However, data on the presentation and results of treatment in Indian patients are scarce. We reviewed the clinical and pathological data and the treatment outcome of patients with Hodgkin's disease seen at our centre over the last 15 years., Methods: The case records of 289 patients diagnosed to have Hodgkin's disease at our centre between 1977 and 1992 were reviewed. Their clinical characteristics, treatment outcome and prognostic factors for survival were analysed., Results: The median age of the patients was 26 years with 30% being in the third decade. The male:female ratio was 4:1. The mixed cellularity histological subtype was the most common (68.5%), followed by nodular sclerosis (8.9%). 'B' symptoms were present in 73% of patients and 9.4% had bone marrow involvement. At the time of presentation, 70% of patients had advanced disease (stage III: 36%, stage IV: 34%). Complete response to treatment was obtained in 65.7% of patients while 17.3% had partial response. The predictors of decreased overall survival were age > 40 years, presence of 'B' symptoms, lymphocyte depletion histological subtype and stage IV disease. Disease-free survival was influenced by the presence of 'B' symptoms, bone marrow involvement and stage IV disease., Conclusion: Hodgkin's disease in Indian patients has a distinct clinico-pathological profile. Combination chemotherapy has high response rates even in patients with advanced disease at presentation.

Non-Hodgkin's lymphoma (NHL) arising from extra nodal tissue and staying localized to that region is rare. Rarer still is primary NHL of the uterine cervix. We describe a patient with primary extra nodal NHL of the uterine cervix and vagina who was treated successfully with chemotherapy and radiotherapy. She is free of disease 17 months after treatment. Data of 52 patients collected from the literature (Medline, National Library of Medicine, Bethesda, MD) is reviewed.

A case of splenic vein obstruction due to infiltration by Hodgkin's lymphoma of the colon is reported. The patient presented with massive upper gastrointestinal hemorrhage and a lump in the abdomen. Laparotomy revealed a colonic tumor infiltrating the splenic vein, causing left sided portal hypertension.

Two patients with primary Hodgkin's disease of the small intestine are reported because of rarity of this condition. Both patients presented with primary intestinal symptoms and were diagnosed after surgical resection. The modalities of treatment and favorable long term survival are presented.

A patient with peripheral polyneuropathy, hepatosplenomegaly, osteosclerotic myeloma in the ilium, hyperpigmentation and hypertrichosis is described. A diagnosis of POEMS syndrome was made. This is the first report of this syndrome from India.

A case of pseudolymphoma from India is being reported which had been masquerading for quite some time as a case of borderline leprosy. The patient has been having for the past 16 years, recurrent, occasionally pruritic, multiple, bilateral, erythematous papules and plaques, which on casual examination elsewhere had suggested leprosy.

An analysis of 128 cases of Hodgkin disease seen at the Department of Pathology, All India Institute of Medical Sciences, New Delhi, during the period 1968--1974 is presented with reference to histopathological and clinical findings. A male preponderance is noted in all age groups, and this is most noticeable in children under 15 years of age. There is a predominance of cases with the histologic subtypes associated with a poor prognosis (mixed cellularity and lymphocyte depleted). Only nine cases of nodular sclerosis type were seen.