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A 45 year old male presented with multiple, painless, hard nodular swelling over scrotum of two years duration. The nodules gradually increased in size. There was no history of trauma or any systemic illness. A provisional diagnosis of sebaceous cyst of scrotum was made. His haematological and biochemical parameters were normal. En-block excision of lesion was done. Histopathological diagnosis of calcinosis cutis was made and confirmed by Von Kossa stain. We report herewith a case of idiopathic calcinosis cutis of scrotum and review the literature regarding pathogenesis and management.

Background. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has attempted to standardize reporting and cytological criteria in aspiration smears. Aims. The objective of this study was to analyze the thyroid cytology smears by TBSRTC, to determine the distribution of diagnostic categories and subcategories, to analyze cytological features, and to correlate the cytopathology with histopathology, wherever surgery was done. Materials and Methods. This was a prospective study of 225 fine needle aspirations (FNA) of thyroid nodules. All fine needle aspiration cytology (FNAC) diagnoses were classified according to the features given in the monograph of TBSRTC into nondiagnostic/unsatisfactory (ND/UNS), benign, atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), follicular neoplasm/suspicious of a follicular neoplasm (FN/SFN), suspicious for malignancy (SFM), and malignant. Cytohistological correlation was done, when surgical material was available. Results. The distribution of various categories from 225 evaluated thyroid nodules was as follows: 7.2% ND/UNS, 80.0% benign, 4.9% AUS/FLUS, 2.2% FN, 3.5% SFM, and 2.2% malignant. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated. Conclusions. TBSRTC is an excellent reporting system for thyroid FNA. It also provides clear management guidelines to clinicians to go for follow-up FNA or surgery and also the extent of surgery.

A 52 years old lady was diagnosed to have Tuberous Sclerosis Complex (TSC) on the basis of 2 major and one minor criterion. She had family history of similar complaints in her sister and two sons. There was involvement of kidney in the form of angiomyolipoma, skin in the form of facial angiofibroma and teeth with a dental pit. She had an unusual lung involvement in the form of multiple small choristomas. Choristoma was diagnosed on transbronchial lung biopsy and was present in the form of disorganised striated muscles. The reported pulmonary manifestations of TCS i.e. lymphangioleiomyomatosis (LAM) and multifocal micronodular pneumocyte hyperplasia (MMPH) are types of hamartomas. Hamartomas and choristomas are both types of disorganized tissue. 'Choristoma'of lung in TSC however is not reported. Clinopathological correlation of pulmonary hamartoma and choristoma, and treatment in TSC has been discussed.

Background This study aims to study predictors of posterior encephalopathy syndrome in eclampsia and the impact of posterior encephalopathy syndrome on outcome. Material and methods This prospective study enrolled consecutive women with eclampsia. These women were subjected to magnetic resonance imaging of the brain. Predictors of posterior encephalopathy syndrome were determined using univariate, followed by multivariate, analysis. Women were followed for 30 days. Maternal outcome was assessed using modified Rankin scale (mRS). Results One hundred and four consecutive women with eclampsia were included. Seventy-four women with eclampsia had posterior encephalopathy syndrome. Predictors of posterior encephalopathy syndrome were primigravida status, altered sensorium, impairment of vision, vomiting, status epilepticus, unregistered status in a regular ante-natal check-up programme, lactate dehydrogenase, uric acid, low platelet count and deranged kidney and liver functions on univariate analysis. On multivariate analysis, vision impairment, primigravida status, and unbooked pregnancy were independent factors. Posterior encephalopathy syndrome was associated with a poor maternal and fetal outcome. Conclusion Vision impairment, primigravida status, and unbooked pregnancy are independent predictors of posterior encephalopathy syndrome, that in turn is associated with a poor maternal and fetal outcome.

Background: Metabolic syndrome (MetS) is associated with mental illnesses. It is a major predictor of mortality and morbidity in patients of such mental illnesses. This study was undertaken to study the association of MetS and schizophrenia. Objectives: To study the association of MetS in patients of schizophrenia. Materials and Methods: Adult schizophrenic patients diagnosed as per Diagnostic and Statistical Manual -IV Third R evisioncriteria visiting the psychiatric Out Patient Day during the study period were evaluated for prevalence of MetS as per the criteria of the international diabetes federation. Fifty patients of schizophrenia with age-and sex-matched 50 controls were enrolled for the study. Results: MetS was found to be 28% in patient group and 12% in control group (P < 0.05). Fourteen patients were found to have MetS out of 38 patients who were on antipsychotics for >6 months. All the 14 patients having MetS were taking second-generation antipsychotics (SGAs) ( P < 0.05). Conclusion: The study showed a higher prevalence of MetS in schizophrenia than in general population. MetS was present only in patients taking SGAs and prevalence of MetS had a positive correlation with duration of treatment. The study points toward urgent need for consultation - liaisoning between Diabetologist and Psychiatrists.

Background. Soft tissue tumors are defined as nonepithelial extraskeletal tissue of the body exclusive of the reticuloendothelial system, glia, and supporting tissue of various parenchymal organs. The absence of recognizable tissue architectural patterns in cytological preparation makes diagnosis by FNAC more difficult. Aims. To assess the utility of FNAC in diagnosing soft tissue tumors and to determine their patterns compared with with the respective histopathology results. Materials and Methods. 150 cases of soft tissue tumors were included in this study for cytologic and histologic correlation. FNAC air dried smears were stained with Giemsa stain and 95% ethanol fixed smears were stained with Papanicolaou stain. The smears were studied for cytological diagnosis and were categorized as benign, suspicious of malignancy, and malignant along with specific subtyping of the lesion. All diagnostic FNAC results were compared for diagnostic concordance using histology results as the “gold standard.” Results. The sensitivity, specificity, positive predictive value, negative predictive value, and efficiency were 70%, 100%, 97.90%, 100%, and 98%, respectively. P value was <0.0001 which shows statistically extreme significant correlation. Conclusion. FNAC is a very important preliminary diagnostic tool in palpable soft tissue lumps with high degree of correlation with the final histopathology report.

A 13-year girl presented with fever, chest pain, cough, and decreased appetite of 15 days. General and respiratory examination was normal. Routine investigations were normal. Sputum for AFB was negative. Chest X-ray revealed bilateral miliary nodules. Eye examination showed choroid tubercles with chorioretinitis. She was diagnosed as disseminated TB and started on ATT daily regime with oral prednisolone. After 5 days, she developed pneumothorax and ICD was inserted. CECT chest showed bilateral multiple miliary nodules with bilateral pneumothorax. She had recurrence (6 times) of Pneumothoraces during 3 months and managed with ICD. She underwent thoracoscopic surgical biopsy for confirmation of diagnosis. Immunohistocytology was negative for CD1a and HMB45. Biopsy was consistent with TB. The final diagnosis was miliary tuberculosis with bilateral recurrent Pneumothoraces. ATT continue for 9 months with tapering of steroid. Chemical pleurodesis was performed. She was followed up for 2 years with no recurrent of pneumothorax. Bilateral recurrent pneumothorax is rare complication of miliary TB.

Background: The crocidolite variety of asbestos is banned. However, chrysotile, which is not prohibited, is still used in developing countries in making products such as clutch plate. Fourteen workers from a small-scale clutch plate-manufacturing factory were analyzed for asbestos-induced lung disease as one of their colleagues had expired due to asbestosis. Aims: This study was conducted to evaluate the awareness of workers, the prevalence and type of asbestos-induced lung disease, and the sensitivity and specificity of diffusion test. Materials and Methods: History, examination, chest radiograph, spirometry with diffusion, and high resolution computed tomography (HRCT) thorax was performed in all the workers. The diagnosis of asbestos-induced lung disease was suspected on the basis of HRCT. This was subsequently confirmed on transbronchial lung biopsy (TBLB). Results: None of the workers had detailed information about asbestos and its ill effects. Eleven out of 14 (71.42%) workers had asbestos-induced lung disease. All 11 had small airway disease (SAD). Three had SAD alone, 6 had additional interstitial lung disease (ILD), and 2 patients had additional ILD and chronic obstructive pulmonary disease. Sensitivity and specificity of residual volume (RV) or total lung capacity (TLC) for detecting SAD was 90% and 100%, respectively, and that of diffusion capacity of lung for carbon monoxide (DLCO) for detecting ILD was 100%. Conclusion: The awareness about asbestos in small-scale clutch-plate manufacturing industry is poor. The usage of chrysotile should be strictly regulated as morbidity and mortality is high. DLCO and RV/TLC are sensitive and specific in detecting nonmalignant asbestos induced lung disease.

Context: Pancytopenia is not a disease but a clinico-hematological entity encountered in clinical practice. A prompt intervention is required to avoid complications, which can occur in these patients. The relevant clinical history and complete hematological workup is required to treat patient of pancytopenia. The severity of pancytopenia and the underlying pathology determines the management and prognosis. Aims: To diagnose different conditions producing pancytopenia on the basis of clinical, hematological and bone marrow studies. To estimate the frequency of different diseases producing pancytopenia. Subjects and Methods: The study was conducted in Department of Hematology of our college in capital city of India. A prospective study was carried out among 100 consecutive patients with pancytopenia. Blood samples of the patients were analyzed for red cells, white cells and platelets morphology along with presence and absence of immature cells and abnormal cells. In bone marrow examination, morphology of all cells lineage, cellularity, parasite and abnormal cells were scrutinized. Trephine biopsy was done where ever indicated. Results: The age of patients ranged from 5 to 80 years. 74% of patients in this study were vegetarian. The most common cause of pancytopenia was megaloblastic anemia (66%) followed by aplastic anemia (18%), malaria (6%), kala-azar (4%), acute myeloid leukemia (2%), multiple myeloma (2%), myelodysplastic syndrome (1%), and tuberculosis (1%). Conclusions: The present study concludes that detailed primary hematological investigations along with bone marrow examination in cytopenic patients is helpful for understanding disease process, to diagnose or to rule out the causes of pancytopenia. It is also useful in planning further investigations and management.

Fine-needle aspiration was used to diagnose a case of maxillary myxoma. Abundant mucoid material was obtained. Microscopic examination showed three-dimensional fibrillary myxoid fragments entangling spindle-shaped, stellate, and fusiform cells with round to oval monomorphic nuclei. A striking feature was delicately branching capillaries. The diagnosis was subsequently con-finned on histology and histochemistry.