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Introduction: Fine needle aspiration cytology (FNAC) is a simple cost-effective and rapid diagnostic modality for the evaluation of breast lumps. The aim of the present study was to correlate the cytological diagnosis with histopathological ndings and to nd out the accuracy of FNAC in the evaluation of breast lesions. FNAC is very helpful in distinguishing benign from malignant lesions and deciding the further management of the patient. Materials And Methods: The study comprised of 250 cases of FNAC of palpable breast lesions with histological correlation. All the aspirates were examined using PAP and Giemsa stains. The accuracy of FNAC was calculated by determining the sensitivity, specicity, positive predictive value, negative predictive value and accuracy. Results: Total 250 cases were studied of which there were 246 female and 4 male patients. A concordant diagnosis was made on FNAC in 134 out of 136 of benign lesions, one of two cases of suspicious for malignancy and all 112 cases of malignant lesions. Fibroadenoma(FA) (63.2%) was the commonest benign lesion observed while ductal carcinoma (42%) was the most frequent malignancy seen. In the diagnosis of breast lesions FNAC had a sensitivity of 99.12%, specicity of 98.54%, positive predictive value of 98.25%, negative predictive value of 99.26% and accuracy of 98.8%. Conclusion: FNAC is a reliable tool for diagnosis of breast lesions. It is minimally invasive and is a good alternative to biopsy in the diagnosis of benign lesions. However for the cases which fall into “suspicious for malignancy” category biopsy is advisable.

Conjunctival myxomas are very rare benign tumours of mesenchymal origin which pose a diagnostic challenge clinically and radiologically. They usually present as asymptomatic slowly growing cystic lesions involving the bulbar conjunctiva. Two cases were with usual presentation while one was with unusual presentation. Two cases of conjunctival myxoma (59 year old female patient and 65 years old male patient) involving the bulbar conjunctiva and one (56 years old female patient) in the palpebral conjunctiva are reported. Anterior segment examination and fundoscopy were within normal limits. A clinical diagnosis of conjunctival cyst, pinguecula and pyogenic granuloma was made in the three cases, respectively. Excision was done in all the cases and a diagnosis of myxoma was made based on the characteristic histological and immunohistochemical features. No systemic involvement was seen. The authors hereby report the present cases because of their rarity and to emphasise that, histopathology is required to distinguish it from other conjunctival lesions.

BACKGROUND: Guttate psoriasis (GP) and pityriasis rosea (PR) are a part of papulosquamous disorders that have very similar clinical features and often require histopathology to confirm the diagnosis. Dermoscopy has emerged as a noninvasive, cost-effective technique that can aid in the diagnosis of inflammatory skin diseases like GP and PR. OBJECTIVE: To study and compare the dermoscopic features of GP and PR. METHODS: Twenty consecutive patients each with GP or PR were enrolled in the study. The diagnosis of GP and PR were made clinically and on histopathology. Dermoscopic images were taken of the representative lesions from each patient using a manual dermoscope attached to a digital camera after applying ultrasound gel. Vascular morphology, vascular arrangement, background color, along with color and distribution of scales were noted in each case. Statistical analysis was done using chi-square test to determine the significance of findings in both groups. RESULTS: The combination of a bright red background with dotted vessels in uniform diffuse distribution with diffuse white scales was highly specific for the diagnosis of GP. Lesions of PR showed a red background with dotted blood vessels in nonspecific distribution. Scales were either white in color or brown pigmented with patchy distribution. Brown pigmentation and brown dots were additional findings in cases of PR. CONCLUSIONS: Combinations of dermoscopic patterns can aid in the diagnosis of GP and PR in the majority of the cases.

Foregut cysts of the oral cavity are rare developmental anomalies which are lined by gastric, intestinal, squamous or respiratory epithelium or a mixture of these epithelia. A 10-year-old boy presented with a large cyst in the floor of the mouth and had difficulty in speech and chewing of food. On Magnetic Resonance Imaging (MRI) examination a diagnosis of ranula was given. Surgical excision was done and a diagnosis of foregut cyst lined by respiratory epithelium was given on histopathological examination. Till now only 21 cases of lingual foregut cyst with respiratory lining have been reported. We report the 22nd case for its rarity and because these lesions can pose a diagnostic dilemma and should be included in the differential diagnosis of cystic lesions in the oral cavity especially in paediatric population.

Background: Guttate psoriasis (GP) and pityriasis rosea (PR) are a part of papulosquamous disorders that have very similar clinical features and often require histopathology to confirm the diagnosis. Dermoscopy has emerged as a noninvasive, cost-effective technique that can aid in the diagnosis of inflammatory skin diseases like GP and PR. Objective: To study and compare the dermoscopic features of GP and PR. Methods: Twenty consecutive patients each with GP or PR were enrolled in the study. The diagnoses of GP and PR were made clinically and on histopathology. Dermoscopic images were taken of the representative lesions from each patient using a manual dermoscope attached to a digital camera after applying ultrasound gel. Vascular morphology, vascular arrangement, background color, along with color and distribution of scales were noted in each case. Statistical analysis was done using chi-square test to determine the significance of findings in both groups. Results: The combination of a bright red background with dotted vessels in uniform diffuse distribution with diffuse white scales was highly specific for the diagnosis of GP. Lesions of PR showed a red background with dotted blood vessels in nonspecific distribution. Scales were either white in color or brown pigmented with patchy distribution. Brown pigmentation and brown dots were additional findings in cases of PR. Conclusion: Combinations of dermoscopic patterns can aid in the diagnosis of GP and PR in the majority of the cases.

Falciparum malaria is known to cause severe malaria with multiorgan involvement while Vivax malaria is thought to run a benign course. However recent studies have reported complications even in vivax malaria and mixed infections. A prospective observational study was conducted for a period of 2 years on all patients who tested positive for malaria by smear examination or antigen test. A comparative evaluation of clinical features diagnostic methods, hematological profile and biochemical profile of patients presenting with vivax falciparum and mixed infection was done..Appropriate statistical analysis was done to compare the various parameters. There were 197 cases of vivax,76 cases of falciparum and 27 cases of mixed infection out of the total 300 malaria cases. Headache, diarrhoea, vomiting, hepatomegaly, jaundice, anaemia, raised bilirubin, liver enzymes and creatinine were more common in mixed and falciparum infections than in vivax infection while splenomegaly and thrombocytopenia was more common in P. vivax and mixed malaria. Only falciparum cases showed convulsions and acute renal failure, while respiratory distress was seen in both vivax and falciparum infections.Though falciparum and mixed infections present more frequently with complications and altered laboratory parameters even vivax infection can present with severe malaria in less proportion of the cases.

Monotypic angiomyolipoma is usually found in the kidneys and is composed predominantly of epithelioid cells which show positivity for melanocyte and smooth muscle markers. It can pose a diagnostic challenge due to a range of differential diagnosis. We report the second case of monotypic angiomyolipoma of nasal cavity and first from India in a 54-year-old male who presented with a nasal polyp. Grossly the tumor was well circumscribed and un-encapsulated. Microscopy showed a large number of epithelioid cells mixed with a few spindle cells, varying sized blood vessels, and focal areas of adipose tissue. Immunohistochemistry was positive for smooth muscle actin (SMA) and human melanoma black (HMB-45) stains. It is important to identify this tumor as it can sometimes be mistaken for malignancy and only needs endoscopic resection.

Introduction: In India alone in year 2000 there were 30 million people to suffered with Coronary Heart Diseases (CHD). CHD has 3% prevalence and incidence of Heart failure with CHD is about 0.4% to 2.3% per year. There are many traditional and nontraditional risk factors that are associated with cardiovascular diseases (CVD). Atherosclerosis is not only a lipid disorder but it is the process of active communication between endothelial dysfunction, sub-endothelial inflammation and wound healing process of vascular smooth muscle cells. Inflammation leading to atherosclerosis results in a CAD where innate and adaptive immune systems play a major role. Interleukin-1 (IL-1) also has a major role in the development of atherosclerotic CAD by promoting atherogenesis. Aim: To determine serum IL-1β levels for detecting CVD patients from Western Maharashtra population. Materials and Methods: We recruited 229 cases of CVDs (16 cases of complete heart block, one case of congenital heart disease, 22 cases of heart failure, 169 cases of myocardial infarction, one case of myocarditis and 20 cases of rheumatic heart disease) who were enrolled at Cardiology and Medicine Department of Lokamanya Tilak Municipal General Hospital, Sion, Mumbai along with 229 age and sex matched healthy controls were included in this case control study. Serum IL-1β was measured with commercially available ELISA kit. Cut-off level for estimation of IL-1β was done with Receiver Operative Curve (ROC) analysis. Statistical analysis was carried out using SPSS version 16.0 and Microsoft Excel 2007. Results: The median and Inter Quartile Range (IQR) level of IL-1β in CVD group was significantly higher than control group (p-value

Serous papillary cystadenofibromas (SPCAFs) of the fallopian tube are very rare benign tumors of the female genital tract. They are usually asymptomatic and are found incidentally. Until now, only 18 cases of this tumor have been reported in the world literature. We report a case of SPCAF of the left fallopian tube in a 30-year-old female who presented with a large abdominal mass and pain. On computed tomography, a diagnosis of ovarian neoplasm was given. However, during surgery the tumor was found to arise from the fallopian tube and was treated with tubal cystectomy with sparing of the ovary. We present this unique case on account of its rarity, unusual presentation, and huge size along with a short review of literature.

Kikuchi-Fujimoto Disease (KFD) is a self-limiting necrotizing lymphadenitis that usually presents with fever and cervical lymphadenopathy. Recognition of this condition is crucial, because it can be mistaken for tuberculosis, lymphoma and connective tissue disorders. When present at an unusual location the diagnosis can be challenging. We present an unusual case of Kikuchi-Fujimoto disease involving mesenteric lymph node masquerading as acute appendicitis along with its differential diagnosis. A 30-year-old female presented with complaints of acute abdominal pain, vomiting and fever. Physical examination revealed rebound tenderness in the right iliac fossa. The abdominal sonography was suspicious of acute appendicitis. The patient underwent appendectomy with excision of an enlarged mesenteric lymph node. On histopathology mesenteric node showed features of KFD which was confirmed on immunohistochemistry. Appendix was unremarkable. Although rare KFD should be added to the differential diagnosis of acute appendicitis in patients with enlarged mesenteric lymph nodes, Awareness of this disorder helps to prevent misdiagnosis and inappropriate treatment.

Spindle Cell Lipoma (SCL) is an uncommon benign tumour of adipose tissue that is usually superficially located in the neck, back and shoulder region. Although it has characteristic histological features it can pose a diagnostic dilemma on cytology. It presents with a mixture of spindle cells, adipocytes, collagen fibres and a myxoid matrix in varying proportions sometimes with mild pleomorphism. Hence, it can be mistaken for other spindle cell, adipose and myxoid tumours which can be benign or malignant. We present a case of SCL of the back in a 47-year-old male, who presented with a slow growing lesion. Fine Needle Aspiration Cytology (FNAC) showed the characteristic cytological features described above and a diagnosis could be given after clinical correlation. We report this case as the cytology of this uncommon tumour has been described in relatively few cases and a correct pre-operative diagnosis will aid in proper management of this tumour.

Pure uterine lipoma is a rare entity with only a few cases having been reported in the literature. They usually develop in postmenopausal woman and are mistaken for leiomyomas both clinically and on ultrasound examination. Magnetic resonance imaging (MRI) is the best modality for its preoperative diagnosis. Uterine lipoma has been reported in association with other lesions like endometrial carcinoma, cervical carcinoma and struma ovarii. We present a case of pure lipoma of the uterus with a coincidental benign brenners tumor of the ovary in a 60-year-old female. Patient presented with pain in the abdomen and a preoperative diagnosis of leiomyoma was made based on ultrasonography findings. Gross examination revealed a fatty tumor with a nodule in the right ovary. Microscopy confirmed the presence of pure uterine lipoma with a co-existent brenners tumor of the ovary. To the best of our knowledge this is the first case of uterine lipoma to be reported in association with ovarian brenners tumor.

A breast mass in a postmenopausal age woman is treated with a high index of clinical suspicion for malignancy. Myofibroblastoma (MFB) of the breast is a very rare benign stromal tumor, predominantly occurring in menopausal women and older men. Owing to its rarity, nonspecific radiology, cytomorphology, and many variants, it can be confused with other malignant and benign breast lesions and hence can be a source of diagnostic pitfall. We present a case of an MFB of the breast in a 55-year-old female, which was detected on a routine screening mammography. Fine-needle aspiration cytology was inconclusive. Final diagnosis was made by histopathology and immunohistochemistry examination. We report this case as the likelihood of encountering MFB has increased in recent years due to routine mammographic screening, and this lesion should be kept in the differential diagnosis of spindle-cell lesions of the breast.

Pedunculated lymphangiomatous polyps of the tonsil are rare benign lesions that have been described in literature using varied nomenclature. Majority of the cases have been reported in adults with varying clinical symptoms. We report a case of lymphangiomatous polyp of left palatine tonsil in a 14-year-old male child who presented with dysphagia and dysarthria. Clinical examination revealed a large pedunculated polyp arising from upper pole of left tonsil. Patient underwent left tonsillectomy with excision of the polyp. Based on histopathological features a diagnosis of pedunculated lymphangiomatous polyp was made. We discuss the clinical and histopathological features of this lesion with differential diagnosis and short review of literature.

Primary cutaneous large B-cell lymphoma (Bcl) is defined as a lymphoma composed of large cells constituting more than 80% of the infiltrate and absence of extracutaneous involvement after staging investigations. In the new World Health Organization/European Organization for Research and Treatment of Cancer classification, cutaneous Bcls with large cells are of three types - primary cutaneous large Bcl leg type (PCLBCLLT), primary cutaneous follicle center lymphoma diffuse type (PCFCLDT), and primary cutaneous large Bcls other (PCLBCLO). These three different types are distinct in terms of their clinicopathological features and survival. The PCLBCLO has intermediate features between those of PCLBCLLT and PCFCLDT. We present a case of PCLBCLO in a 57-year-old male who presented with a scalp swelling. Ultrasonography examination was suggestive of a sebaceous cyst. Computed tomography scan revealed the presence of an ill-defined hyperdense region in the soft tissue of the scalp region extending into the deeper layers of the scalp. Fine-needle aspiration cytology (FNAC) revealed the presence of atypical lymphoid cells. Diagnosis was confirmed by biopsy and immunohistochemistry. Patient received rituximab combined with doxorubicin, vincristine, cyclophosphamide, and prednisolone regimen with complete resolution of the lesion. We present this case for its rarity, the utility of FNAC in early diagnosis, and to discuss the differential diagnosis.

Myoepithelial carcinoma (MC) is a rare neoplasm of the salivary gland generally occurring in the parotid gland and rarely in the minor salivary glands. It poses a diagnostic challenge on fine-needle aspiration (FNA) cytology because it can show different cell types and lack clear features of malignancy. This can lead to a range of differential diagnosis on cytology. The diagnostic difficulty can be compounded if the lesion is present at an unusual site. A 41-year-old male presented with a recurrent swelling on the check since 2 years with a prior history of pleomorphic adenoma (PA) at the same site 8 years back. FNA was performed and a diagnosis of recurrent PA or myoepithelial cell neoplasm was given. Final diagnosis was made on histology and immunohistochemistry studies and reported as MC of minor salivary gland originating within PA. Pathologist should be aware of the occurrence of MC at the sites of the minor salivary glands in the oral cavity and its wide morphologic spectrum to make a confident diagnosis of MC preoperatively.

Vascular malformations (VMs) are structural malformations of vascular development causing soft tissue abnormality with functional and esthetic impairment. They are named by their predominant vessel type as arterial, venous, lymphatic or mixed types. VMs of the parotid gland are extremely rare and constitute a distinct entity of parotid pathology that requires specific diagnostic tools and management. Till 2013, only fifty cases of VMs of the parotid have been described in the literature. We present a case of a venolymphatic malformation of the parotid gland extending into the parapharyngeal space in a 21-year-old male who presented with a swelling on the left side of the face extending into the neck. Diagnosis was suggested by ultrasonography and computed tomography scan and was confirmed by magnetic resonance imaging examination. Complete surgical excision of the lesion was done with a favorable outcome. Diagnosis was confirmed based on histopathology and immunohistochemical studies.

Endometrial stromal sarcomas are rare mesenchymal tumors observed in pre- and peri-menopausal age group. The diagnosis is made postoperatively, but a high index of suspicion is needed. The usual presentation is lump in abdomen and abnormal vaginal bleeding. Endometrial sampling, ultrasound, and magnetic resonance imaging help in preoperative diagnosis. Total abdominal hysterectomy with bilateral salpingo-oophorectomy is the main line of management. This article describes its occurrence in a young woman, who presented without the usual clinical features of lump or abnormal vaginal bleeding. The diagnosis was established postoperatively and was confirmed with specialized tests such as immunohistochemistry and mutation studies.

Papillary cystadenocarcinoma (PCAC) is a rare salivary gland tumor characterized by a predominantly cystic growth that often exhibits intraluminal papillary growth without specific histologic features of other cystic salivary gland tumors. The preoperative cytological diagnosis can pose a diagnostic challenge as it has to be differentiated from other cystic papillary tumors such as mucoepidermoid carcinoma, papillary cystic variant of acinic cell carcinoma, and low-grade cribriform CAC. It is considered to be a low-grade malignant salivary gland tumor with an indolent biological behavior. We report a case of PCAC of the parotid in a 55-year-old male diagnosed on fine needle aspiration cytology. Although it showed mild atypia cytologically, on excision tumor showed vascular and perineural invasion with regional node metastasis indicating a wider morphologic spectrum than what is described. This prompted us to write a case report describing the cytological and histological features of this rare tumor and also discuss the diagnostic challenges.

Ectopic breast is a congenital anomaly of the breast which can have varied presentations because of its different sites and pathologies arising from it. Lesions of ectopic breast tissue (EBT) are commonly seen due to persistence of embryonic remnants along the milk line. They have also been reported from other sites like face, vulva, and perineum. They are prone to the same physiological and pathological alterations seen in the normal breast. Only 0.3% of breast carcinomas arise in the ectopic breast, whereas only a few cases of fibroadenoma have been reported at this site. We present a case of polymastia in a 21-year-old female in the inframammary region. We report two cases of fibroadenoma and carcinoma arising from EBT in the axilla of a 26 and 45-year females. Fibroadenoma was treated by simple excision while for carcinoma modified radical mastectomy was done followed by radiation and chemotherapy. Patient developed metastasis in the sternum. Carcinoma arising from EBT has a poorer prognosis and needs early diagnosis and treatment.

Renal cell carcinoma (RCC) is noted for its unpredictable clinical behavior. It can present with metastatic disease at many unusual sites, even after a long latency. It can thus mimic many other lesions and pose a diagnostic challenge, especially in cases where prior history of RCC is not available. Fine-needle aspiration cytology (FNAC) can be very useful in arriving at a correct diagnosis of these lesions. We present an unusual case of RCC in a 55-year-old female who presented with frontal soft tissue mass. A history of nephrectomy 10 years back was not given at the initial presentation. Computed tomography suggested a diagnosis of cavernous hemangiomas. FNAC was suggestive of RCC. Avascular osteolytic lesion in the calvarium should raise the suspicion of metastatic RCC as one of the differential diagnosis.

Pemphigoid vegetans is a very rare type of bullous pemphigoid which usually affects the elderly and has not been reported in children. It shows a clinical resemblance to pemphigus vegetans but has distinct histological and immunopathological features of bullous pemphigoid. A 9-year-old girl presented with recurrent purulent and verrucous vegetating lesions on her forehead, groin and vulva along with scaling, crusted, bullous and purulent lesions on the eyelids, periorbital, periauricular, perioral region and lips. She had oral lesions and a cerebriform tongue. Though she showed clinical features of pemphigus vegetans, histology revealed a subepidermal blister with the absence of acantholysis. Direct immunofluorescence studies were suggestive of bullous pemphigoid. On clinicopathological correlation, a diagnosis of pemphigoid vegetans was made. She responded well to oral corticosteroids and dapsone therapy with complete resolution of the lesions.

Low-grade adenosquamous carcinoma (LGAS) is an uncommon form of invasive mammary carcinoma. Though, it is categorized as a variant of metaplastic carcinomas, which are highly aggressive tumors, this tumor is relatively indolent with a good prognosis. Even though, it shows infiltrative growth LGAS carcinoma exhibits bland cytological features and can be mistaken for benign and other low-grade lesions. Hence, it poses a diagnostic challenge on cytology, core needle biopsy and frozen sections. It has a risk of local recurrence after incomplete excision and has a low metastatic potential. Hence, distinction from the benign mimics is essential in order to plan a proper treatment of either wide excision or mastectomy. We report a case of LGAS carcinoma of breast in a 57-year-old female along with the review of literature and differential diagnosis to highlight the diagnostic challenge it poses.

Purpose: To examine the effect of riboflavin/UVA corneal crosslinking on stromal ultrastructure and hydrodynamic behaviour.\ud Methods: One hundred and seventeen enucleated ungulate eyes (112 pig and 5 sheep) and 3 pairs of rabbit eyes, with corneal epithelium removed, were divided into four treatment groups: Group 1 (28 pig, 2 sheep and 3 rabbits) were untreated; Group 2 (24 pig) were exposed to UVA light (3.04 mW/cm2) for 30 minutes and Group 3 (29 pig) and Group 4 (31 pig, 3 sheep and 3 rabbits) had riboflavin eye drops applied to the corneal surface every 5 minutes for 35 minutes. Five minutes after the initial riboflavin instillation, the corneas in Group 4 experienced a 30 minute exposure to UVA light (3.04 mW/cm2). X-ray scattering was used to obtain measurements of collagen interfibrillar spacing, spatial order, fibril diameter, D-periodicity and intermolecular spacing throughout the whole tissue thickness and as a function of tissue depth in the treated and untreated corneas. The effect of each treatment on the hydrodynamic behaviour of the cornea (its ability to swell in saline solution) and its resistance to enzymatic digestion were assessed using in vitro laboratory techniques.\ud Results: Corneal thickness decreased significantly following riboflavin application (p