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Vulvar fibroadenoma is a rare entity presenting at an unusual location. Here we present a case of a 45-year-old female, with painless, well-defined mass in the left labia majora for one year. On radiological examination, ultrasonography showed a well-defined rounded heterogeneously hypoechoic space occupying lesion. The mass was excised under local anesthesia. The histopathological examination revealed vulvar fibroadenoma.

Angiokeratoma shows dilatation of capillaries in the upper dermis and it also shows some epidermal changes, like- hyperkeratosis, papillomatosis, and thickening of epidermis or acanthosis .Clinical presentation of angiokeratoma includes plaques over the skin of lower limbs, mostly on the buttocks or thigh. It is usually identified clinically but a definitive diagnosis is made only on histopathological examination.Adeeper biopsy of the lesion is empirically essential to make a concrete diagnosis as the characteristic changes seen in angiokeratoma, are limited to superficial dermis. Our case report has a 24 years old female presenting with unilateral, linear, bluish-black verrucous plaque on the back of left elbow.

Urinary bladder neoplasm is the 10th most common cancer in the world, predominantly affecting males. Nowadays incidence of urinary bladder carcinoma in female has increased. It is a uncommon type carcinoma of urinary bladder. It resembles to non-keratinizing carcinoma of nasopharynx. This study report a case of 65 years old male presented with painless gross hematuria for 3 weeks. Patient was a known case of Meckel's diverticulum. Ultrasonography and cystoscopy showed a mass on lateral wall of urinary bladder measuring 3x3 cm . A radical cystectomy of the urinary bladder tumor was done. He was diagnosed as case of lymphoepithelioma like carcinoma of urinary bladder along with benign prostate hyperplasia and Meckel's diverticulum was made with stage 2.According to the WHO classification criteria, Lymphoepithelioma like carcinoma is a subtype of undifferentiated carcinomas. Immunohistochemical stains are helpful to differentiate Lymphoepithelioma from primary lymphoma of the bladder. Differentiation of LELCB from urothelial carcinoma is important, since it has better prognosis compared to pure urothelial carcinoma. It is important to diagnose this neoplasm for therapeutic as well as prognostic purpose.

Eccrine spiradenoma is one of the rare, benign dermal neoplasm showing eccrine sweat gland differentiation. The literature search accounts for less than 100 reported cases of eccrine spiradenoma. Clinically, the lesion presents as solitary, intradermal, circumscribed, round or oval, firm, painful or tender nodule measuring from 0.3 - 5 cm in diameter. Rarely if ES, presents as multiple lesions, in combination with other types of adnexal tumors such as cylindromas & trichoepitheliomas, it can be considered as a part of the Brooke-Spiegler syndrome. Majority of these tumours appear on the head/face & upper trunk region of the body. Spiradenomas arise in early adulthood in most instances with few reports also of congenital cases and no sex predilection seen. The definitive diagnosis is made by excisional biopsy of the tumour. Complete tumor excision with clear surgical margins is considered the primary treatment for these cases. Here, we present a rare case report of a 58 years old male presenting with a soft, cystic lesion in the left lumbar region of the abdomen for past 2 years duration. Surgical excision of the tumour was done with clear margins and the specimen was sent for histopathological examination. Due to the overlapping histomorphological features, this tumour is often confused with cylindromas and trichoepitheliomas along with other vascular tumours. Eccrine Spiradenoma, although a benign tumour, but malignant transformation has been described especially in long-standing cases or multiple lesions. So, early diagnosis is very important to prevent recurrence and to identify any onset of malignant transformation.

Carcinoma colon ranks third among the commonest cancer in the world, while seen less common in the Asian countries however lately an increasing trend has been observed. Majorly the elderly population is at an increased risk of colon cancer however early onset of the disease has also been observed in past few years. Various histologic subtypes with different prognoses are present, but the most common histological type is Adenocarcinoma (1). Signet-ring cell carcinoma (SRCC) is a known rare subtype of colorectal carcinoma (< 1%) officially recognized by the WHO, mucinous types are aggressive with poor outcomes and are most commonly diagnosed around the fourth to fifth decade of life comprising only 1% of colorectal cancers. So we report a case of a 40-year-old male with adenocarcinoma colon of signet ring cell type. The patient presented with localized abdominal discomfort with only generalized weakness and fatigue which was later evaluated to be a near-obstructing right-sided colonic mass. Patient was taken up for surgery and was found to have diffuse carcinomatosis.

This study’s objective is to evaluate the expression of Octamer-binding transcription factor 4 (OCT-4) as a prognostic biomarker for urinary bladder cancer (UBC) along with its histological grade and tissue invasiveness. It is also called the POU domain, class 5, transcription factor I(POU5FI). OCT-4 protein is a transcription factor and a well-known marker of cancer stem cells. This study aimed to validate the OCT-4 value in urinary bladder cancer. FFPE tissue blocks from ten patients of different grades and invasiveness of urothelial carcinoma were studied and correlated with the degree of OCT-4 expression by immunohistochemistry. The mean histochemical expression score in seven high-grade urothelial carcinoma cases was 8.4 as compared to 5.0 in three low-grade urothelial carcinoma cases. Similarly, the mean histochemical expression score in seven lamina invasive urothelial carcinoma was 5.9 as compared to 7.5 in detrusor muscle-invasive urothelial carcinoma. There was a positive correlation between OCT-4 expression and high grade and invasive urinary bladder cancer.

Rhabdoid tumor is relatively rare highly malignant tumor in adult older than 40 years, therefore treatment regimens often throwing from pediatric age group. It is characterized by extremely aggressive behavior, rapid metastasis to other organ, low survival rate and no targeted therapy. So, early diagnosis is necessary for better treatment and reduce mortality outcome. A 42 years male suffering from a right side cheek mass of 5x3cm associated with tongue displacement to left side and difficulty in swallowing. After complete removal of lesion for histopathological examination, revealed grossly the tumor is well defined gray-white, round, lobulated 5x3cm in size having infiltrating borders. Cut surface shows gray-white to gray-brown, solid areas. Microscopically H&E stained section revealed, sheets of tightly packed large, discohesive, polygonal cells having abundant eosinophilic cytoplasm with eccentrically placed round nuclei showing distinct prominent vesicular nucleoli separated by thin fibrous septae with blood vessels. These cells lie in myxoid background. These tumor cells have deeply acidophilic having finely granular abundant cytoplasm with small, peripherally placed nuclei and abundant intra-cytoplasmic vacuoles along with nuclear pleomorphic, no mitotic figure seen. Histologically, the adult type tumor proliferating as sheet of tightly packed large, discohesive, polygonal cells having abundant eosinophilic cytoplasm with eccentrically placed round nuclei showing distinct prominent vesicular nucleoli separated by thin fibrous septae with blood vessels lie in fibromyxoid background. These tumor cells have deeply acidophilic, finely granular cytoplasm with small, peripherally placed nuclei with occasional intra-cytoplasmic vacuoles along with cross striations, no mitotic figures seen. Study concludes that adult type Rhabdoid tumors have extremely aggressive behavior, rapid metastasis spread to other organs, low survival rate and no targeted therapy. Usually males older than 40years of age are affected. It is crucial to make a rapid correct diagnosis and early treatment may improve the outcome.

Amelanotic melanoma is an uncommon type of of melanoma which lacks melanin pigment (1). Of all the melanoma cases, approximately 2-8% cases represents amelanotic melanoma. The exact prevalence of this malignancy is more due to misdiagnosis. Due to lack of clinical criteria and pigmentation, the condition often detected late (2). Amelanotic melanomas are commonly found on the face, which shows microscopically the characteristics of desmoplasia (desmoplastic melanoma), but other body parts can also be involved (4).

Pyloric gland adenoma is an uncommon precancerous polypoidal growth. Pyloric gland adenoma of stomach accounts for 2.7% of all gastric polyp. Mostly Pyloric gland adenoma are found in stomach but can be found in other anatomical sites. Pyloric gland adenoma of stomach occur in elderly population and having female predominance. Pyloric gland adenoma of stomach is commonly seen in chronic gastritis patients, autoimmune gastritis but can also occur in some genetic disease like familial adenomatous polyposis and Lynch syndrome. Early identification and therapeutic polypectomy by endoscopically and histopathological evaluation and confirmation of pyloric gland adenoma may reduce the chances of transformation of invasive adenocarcinoma.

Gliomas are the tumor of glial cells found in Central nervous System. High Grade Gliomas are rare in pediatric age group. Definitive diagnosis is made by histopathological examination. A 2 ½ year old male admitted with the complaint of abnormal tonic-clonic body movements along with headache, nausea, vomiting and fever. CT scan showed a poorly circumscribed hypodense lesion involving frontoparietal region. Surgery was performed and specimen sent for histopathological examination. Histopathological examination showed mfeatures of high grade glioma like microvascular proliferation, necrosis and haemorrhage. Cerebral tumors are the most common childhood neoplastic tumors. Gliomas are generally classified into low grade glioma and high grade glioma. High Grade glioma is rare in pediatric age group. Most commonly they present in supra tentorial compartment. The most common cerebral cortex involved are frontal lobe followed by parietal and temporal. Clinical signs and symptoms of High grade gliomas are seizure, headache, nausea, vomiting and visual disturbances. CT scan showed a poorly circumscribed hypodense lesion involving left frontoparietal region mainly. Definitive diagnosis of high grade glioma is by histopathological examination. Histopathological examination showed hypercellular heterogeneous tumor lying on a fibrillary background. Areas of microvascular proliferation along with necrosis and haemorrhage are also seen. Surgical resection followed by chemotherapy and local radiotherapy are the present recommendation. High grade gliomas are rare pediatric tumor associated with poor outcome. Surgery was performed due to neurological worsening, which was unsuccessful and patient died. Diagnosis was confirmed on histopathological examination. Poor prognosis and high morbidity even after evolution of treatment, demands further research to improve the prognosis and reduce morbidities.

A Duplication cyst of the oesophagus is the 2nd most common congenital anomaly of the Gastrointestinal tract. It has an estimated prevalence of 0.012% with a higher predominance in males, representing the 10- 15% of all gastrointestinal duplication defects. Although it is a common nding in children, diagnosis of an oesophageal duplication in adults is rare. They are often asymptomatic but they may experience symptoms such as stridor or dysphagia corresponding to the lesion within the neck or mediastinum or be complicated by intracystic haemorrhage, rupture & infections. Here we present a case of an adult patient presenting with an oesophageal duplication cyst

Craniopharyngiomas are rare benign epithelial tumours arising from the pituitary stalk or gland. The sellar and parasellar region is the most commonly involved sites but at times tumors extend below the sellar floor involving the sphenoid sinus, invade the pharynx and reach upto the nasal cavities. Here is a case of 14 years old boy presenting with nasal cavity mass leading to bilateral obstruction and he was operated to excise the mass lesion. Grossly a grayish white cystic mass lesion was obtained after excision biopsy. On cut section, cyst contained a greyish brown thick liquid like material, with the microscopic findings of densely packed nodules of well differentiated epithelium along with stellate reticulum and wet keratin consistent with the diagnosis of craniopharyngioma. Clinical features along with imaging characteristics (except site of the lesion) and histopathological findings were all consistent with primary admantinomatous craniopharyngioma

Paragangliomas are neuroendocrine neoplasm. These neoplasms originate from specialized neural crest cells and have association with segmental or collateral autonomic ganglia. Spinal paraganglioma is rare tumor. We are presenting a case of spinal paraganglioma in a 58 years old male presented with low back pain, his MRI spine showed extramedullary intradural tumor at the level of L1-L2 vertebra .Tumor was excised and patient was discharged after uneventful stay at hospital. Paragangliomas are WHO grade I slow growing tumor, radiologically paraganglioma resembles other lesions, such as schwannomas, ependymomas, meningiomas. Gross total resection of tumor is treatment of choice .Prognosis is good with very rare recurrence rate.

To compare the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of visual inspection with acetic acid with Papanicolaou test. This was cross-sectional study conducted over a period of 18 months. A total of 800 patients attending the gynecology outpatient department of Era’s Lucknow Medical College and Hospital and fulfilling the inclusion criteria and giving their informed consent were included. Out of 800 women from whom Pap smear was obtained, 716 (89.5%) were negative. There were 84 (10.5%) positive cases. Among 800 women screened using VIA, 171 (21.38%) were found to be positive, while 629 (78.62%) were negative. Histopathological evaluation could be done in 155 screened cases. Among these 155 cases, 41 (26.45%) were positive for pre-malignancy and 114 (73.55%) were negative. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of PAP against histopathology were 80.5%, 62.3%, 43.4%, 89.9% and 67.1%, respectively, whereas the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of VIA against histopathology were 87.8%, 5.3%, 25.0%, 54.5% and 27.1%, respectively. The sensitivity of VIA and Pap was nearly equal, i.e., 87.8% and 80.5%, respectively. Pap was found to be more specific than VIA, i.e., 62.3 vs. 5.3%. The findings of the study thus showed that although PAP was more specific than VIA, VIA had a higher sensitivity. Despite a high false positivity rate, it could be recommended as a preliminary screening tool in primary care low-resource settings.

Modified Reid index helps to objectively differentiate between low-grade and high-grade lesions during colposcopy; however, its differentiating ability is often debated. Swede score is a relatively newer score for the purpose. In the present study, we compared the efficacy of modified Reid index and Swede score in evaluation of visual inspection by acetic acid (VIA) positive women. A total of 57 VIA-positive women underwent colposcopic evaluation followed by histopathological confirmation. Women with obvious growth, previous procedures on the cervix, pregnancy, nulliparity and history of pelvic irradiation were excluded. Colposcopic findings were scored using modified Reid index and Swede score, respectively. The diagnostic efficacy of modified Reid index and Swede score was done using sensitivity, specificity, positive and negative predictive values. Mean age of women was 37.53 ± 8.98 years. On colposcopy, according to modified Reid index, a total of 26 (45.6%) were likely to be CIN I, 29 (50.9%) were CIN I/II, and 2 (3.5%) were CIN II/III. According to Swede score, 38 (66.7%) were low grade (normal/CIN I), 11 (19.3%) were high grade (non-invasive CIN II or above) and 8 (14%) were high grade (suspected invasive/CIN II or above). On histopathology, 34 (59.6%) were diagnosed as cervicitis, 10 (17.5%) were low grade (CIN I/mild dysplasia), 5 (8.8%) high grade (CIN II/moderate dysplasia), 2 high grade (CIN III/severe dysplasia) and 6 (10.5%) carcinoma cervix, respectively. For high-grade lesions/carcinoma at a cut-off value 8 or above modified Reid index had sensitivity, specificity, PPV and NPV of 33.3%, 100%, 100% and 92.7%, respectively, as compared to 61.5%, 100%, 100% and 88.6%, respectively, for Swede score at a cut-off > 7. For high-grade lesions, Swede score was found to be more sensitive as compared to modified Reid index in VIA-positive women.

TB in India is extremely common especially in young and adults as compare to other age groups. It is more common in the female population in India where women remain poor and neglected. We present the case of a 35-year-old male who presented with a thyroid lump. On examination, there was a solitary, non-tender, and firm swelling on the left midline neck with no evidence of lymphadenopathy. Ultrasound of thyroid revealed multinodular goiter with the largest nodule (3.5 × 2 cm) in the right lobe of the thyroid. Ultrasound-guided FNAC revealed follicular cells on a background of lymphocytes making a diagnosis of thyroiditis and underwent hemithyroidectomy for the same.

Role of cancer stem cells in the esophageal carcinogenesis is not clear.To assess the expression of CD44 and CD133 cancer stem cell markers in esophageal squamous cell carcinoma (ESCC) and its predisposing lesions by immunohistochemistry.Prospective study as a part of an intramural research project.Tissues samples were obtained with endoscopic biopsy and from surgically resected esophageal specimens. Fifty cases each of histopathologically diagnosed cases of esophageal squamous cell carcinoma and its predisposing lesions (mild, moderate, and severe dysplasia and esophagitis) were evaluated for stem cell marker CD44 and C133 by immunohistochemistry using a scoring system.Chi-square test, analysis of variance (ANOVA), post-hoc tests (Tukey-HSD) were used as appropriate for data analysis. Two sided P0.05 was considered as significant.CD44 expression was significantly higher in ESCC as compared to dysplasia and esophagitis (mean IS 7.92 ± 1.45 vs. 6.34 ± 0.80 vs 5.15 ± 0.86 respectively, P0.001). CD133 expression was also significantly higher in ESCC as compared to dysplasia (mean IS 6.82 ± 1.57 vs. 1.00 ± 0.00 respectively, P0.001) while esophagitis showed no expression. CD44 and CD133 expressions were significantly higher in poorly differentiated ESCC than moderately differentiated and well differentiated lesions (CD44 mean IS 6.94 ± 1.44 vs 8.17 ± 1.38 vs. 8.63 ± 1.02 respectively, P0.001 and CD 133 mean IRS 5.63 ± 0.81 vs 6.00 ± 00 vs. 9.0 ± 00 respectively, P0.001).Significantly higher expression of CD44 and CD133 cancer stem cell markers in ESCC as compared to its predisposing lesions (esophagitis and dysplasia) suggests its role in esophageal carcinogenesis.

Breast carcinoma is the commonest malignancy among women around the world.[1] Annually many cases of breast carcinoma are reported worldwide.[2] In India, it has become the most common carcinoma and replaced the cervical carcinoma in females, mainly in the urban areas.[3] Every year the incidence of breast carcinoma is increasing in India.[4] In India, most patients with breast carcinoma belong to middle to old age group.[5] The incidence of breast carcinoma increases with age and reaches its peak at menopausal age. Various histopathological parameters have prognostic significance in breast carcinoma. This includes histologic subtype, grade, lymph node status, Estrogen receptor/Progesterone receptor status, growth factor and its receptors.[6] It has been found that the assessments of immunohistochemical markers have assumed a significant role in influencing the clinical decisions about the treatment and it is helpful in accessing the prognosis of the patients in breast carcinoma.

Introduction: Telomere Length is critically important in normal cells and telomere shortening in combination with other oncogenic changes— promotes genome instability, potentially stimulating initiation of the early stages of cancer. Aim: The present study was carried out to detect human telomerase reverse transcriptase expression in oral cancer and pre-cancerous lesions by immunohistochemistry. Materials and methods: An observational study was planned in which a total of 45 biopsy specimen of oral mucosa was obtained. Of these, 15 (33.3%) belonged to normal subjects, 15 (33.3%) to subjects found to have Oral submucousal fibrosis and 15 (33.3%) subjects with Oral squamous cell carcinoma. Results: Among cases of OSCC, majority was of well differentiated grade (80.0%), only 1 (6.7%) case was poorly differentiated and rest was of moderately differentiated (13.3%) Labelling intensity of OSCC (78.07 ± 22.31) was maximum followed by that of Normal (44.47 ± 6.32) and minimum of OSMF (26.67 ± 15.05) and intergroup difference and between group differences were also found to be significant. Labelling score of OSCC (154.47 ± 94.74) was maximum followed by that of Normal (84.73 ± 51.51) and minimum of OSMF (46.73 ± 44.25) and intergroup difference and between groups differences (Normal vs OSCC, and OSMF and OSCC) were found to be statistically significant. Conclusion: The present study highlights only the discriminating ability of hTERT for differentiating the malignant condition from premalignant and normal mucosa. Hence, further studies on a larger sample size, with inclusion of other premalignant conditions too are recommended in order to understand the pattern of hTERT expression changes.

Approximately 95% of intussusception occurs in children, However it is a rare entity in adults accounting for 0.003% to 0.02 % of all the hospital admissions. Various causes of intussusception are well known, However intussusception caused by heterotropic pancreas is extremely rare and the rarity increases manifolds if it is in the duodenum of an adult and the cause being heterotropic pancreas. We report this rare case of intussusception due to pancreatic heterotropia in 43 year old male who presented with acute pain abdomen. DOI: http://dx.doi.org/10.3329/bjms.v13i3.12781 Bangladesh Journal of Medical Science Vol.13(3) 2014 p.340-342

Background: Breast cancer is the leading cause of cancer relayed mortality and morbidity among women and the incidence of the disease is rising all over the world. Despite the imaging techniques, histopathological diagnosis still plays an essential role for differential diagnosis and for avoiding surgical over-treatment in case of breast lesions with suspicious features (10). Fine-needle aspiration cytology (FNAC), core needle biopsy (CNB) and vacuum assisted breast biopsy(VABB) represent the current methods of choice for pathological diagnosis, both with their specific advantages and limitations. The purpose of this study is to compare the diagnostic accuracy of FNAC and CNB in patients with US-detected breast lesions as well as the cost effectiveness of the screening modalities in the poor population visiting our institution.Methods: It was a retrospective study done using the department register data where we compared the FNAC findings and compared it with CNB findings in the same cases. This was a short study done for a period of 3 months only from January 2017-March 2017. We collected 50 cases of breast carcinomas where both FNAC and CNB findings as well as the clinical information and follow up were available for the patients. We compiled the data for these cases and slides were reviewed by two independent pathologists to remove observer bias. Authors tabulated clinical information, FNAC diagnosis, CNB diagnosis as well as the stage at presentation and follow up for each case.Results: As is seen in this study that 7 cases which were benign on FNAC were benign on CNB also. As for malignancy while CNB diagnosed 43 cases as malignant FNAC diagnosed 5 cases as suspicious [which were malignant on CNB] and 37 cases as malignant which came out to be malignant in CNB too. So, the while the NPV is 100% the PPV is comparable to CNB.Conclusions: In conclusion, FNAC and CNB represent accurate methods for the characterization of US-detected breast nodules, with similar values of diagnostic accuracy, sensitivity, specificity and NPV. In experienced hands, FNAC could be still considered the first method to evaluate breast lesions being less invasive. CNB has a higher PPV and should be performed for uncertain diagnostic cases and when the evaluation of the invasiveness or histological type of breast lesion is mandatory.

Primary orbital lymphoma is an extremely rare entity; most of the reported cases being MALT lymphoma. Herein we report a case of extranodal primary diffuse large B cell lymphoma in a 17 years old boy who presented with proptosis. The patient responded well to chemotherapy; presently he is in remission with no residual disease.