Placental Site Trophoblastic Tumour – A Rare Cause of Uncontrollable Post - Operative Hemorrhage in Obstetric Cases

Placental site trophoblastic tumour (PSTT) is a rare variant of gestational trophoblastic disease developing from intermediate trophoblasts. PSTTs are incredibly rare tumours with 1 in 100000 pregnancies and only about 200 cases reported till date with mortality reaching up to 25% in undiagnosed c ases. We present the case of a 37year old female, gravida 4 para 3, presenting with uncontrollable post caesarean haemorrhage for which she underwent subtotal hysterectomy. Histopathological examination revealed Placental site trophoblastic tumour. Placent al site trophoblastic tumour, being a rare entity, pose difficulties in its early diagnosis. Delayed diagnosis can lead to distant metastases, thus worsening the prognosis.

A Malignant Granular Cell Tumour with an Unusual Presentation: A Rare Case Report

A granular cell tumour is a tumour of neural origin and is mostly benign and rarely malignant and commonly found in the skin, oral cavity or digestive tract. This report describes a case of a 23 - year - old female with a palpable painless mass on the back near the left axilla with progressive growth. While her laboratory tests and radiological were within normal limits histopathological examination revealed round to polygonal PAS positive atypical cells with large vesicular nuclei and coarsely granular cytoplasm along with foci of spindling an d necrosis which on IHC were S - 100 and CD68 positive and negative for cytokeratin, desmin, EMA. Thus, rendering a diagnosis of a malignant granular tumour of primary origin. This case highlights the importance of accurate histopathological examination to r ecognise and further categorization of Granular cell tumours along with clinical and radiological correlation .

Placental Site Trophoblastic Tumour – A Rare Cause of Uncontrollable Post - Operative Hemorrhage in Obstetric Cases

Placental site trophoblastic tumour (PSTT) is a rare variant of gestational trophoblastic disease developing from intermediate trophoblasts. PSTTs are incredibly rare tumours with 1 in 100000 pregnancies and only about 200 cases reported till date with mortality reaching up to 25% in undiagnosed c ases. We present the case of a 37year old female, gravida 4 para 3, presenting with uncontrollable post caesarean haemorrhage for which she underwent subtotal hysterectomy. Histopathological examination revealed Placental site trophoblastic tumour. Placent al site trophoblastic tumour, being a rare entity, pose difficulties in its early diagnosis. Delayed diagnosis can lead to distant metastases, thus worsening the prognosis.

Enterolithiasis: A Rare Finding in Intestinal Tuberculosis

Though intestinal tuberculosis is relatively a common ailment in India and other developing countries; enterolithiasis is a rarely encountered clinical and radiological entity found in this disease. Enteroliths are formed due to stasis caused by stricture formation in intestinal tuberculosis. We report a case of enterolithiasis secondary to intestinal tuberculosis.

A Rare Case of a Dermoid Cyst of Parotid Gland

Dermoid cysts are benign lesions containing tissues of ectodermal and mesodermal germ layers. The incidence of dermoid cyst in head and neck region is only 7% while in parotid gland only 18 cases have been reported in the literature. An 18-year-old male presented with a slow growing, painless and soft swelling in the right pre-auricular region. According to the patient, he had this swelling since birth. Ultrasonography was suggestive of a 3X3 cm cystic lesion within the right parotid gland. Fine needle aspiration cytology (FNAC) showed predominantly anucleate squames and keratinous debris indicating towards the possibility of a dermoid cyst of parotid. The lesion was surgically excised with superficial parotidectomy, preserving the facial nerve. Histopathology confirmed the diagnosis. Post-operative period was uneventful and patient recovered well. Owing to the rarity of dermoid cysts in the head and neck region and more so within the parotid gland, this case is being reported here.

Malignant Melanoma of Anal Canal – A Diagnostic Dilemma

A 50-year-old male presented with major complaints of bleeding per -rectum and generalized weakness for past one and a half month. Digital rectal examination (DRE) and colonoscopy revealed a thrombosed internal haemorrhoid, which was surgically excised. Histopathological examination (HPE) was pointing towards anal malignant melanoma, which was further confirmed by positive immunohistochemistry (IHC) for HMB-45. As the patient had no secondaries or lymph node enlargement, he was referred for loco-regional radiotherapy. Primary ano-rectal melanoma is a rare but locally aggressive neoplasm capable of early metastasis. Owing to its non-specific clinical presentation it may be mistaken for benign conditions like haemorrhoids and may prove fatal.  Surgical treatment may range from wide local excision (WLE) to abdomino-perineal resection (APR) with controversial role of chemo-radiation in advanced cases. Prognosis is usually bleak with a 5-year survival rate of less than 20%. Owing to the rarity of ano-rectal melanoma and importance of its early detection and management, this case is being reported here.

Trends in Molecular Classification of Breast Carcinoma in a Tertiary Health Care Centre: A 5 year Retrospective Study

Introduction: ER, PR and HER2 are the most important factors for predicting prognosis and response to treatment. In the present study we retrospectively  measured the frequency of estrogen receptor (ER), progesterone receptor (PR), and Her 2 Neu positivity in breast cancer patients during a span of 5 years and classified them into luminal A (estrogen receptor/progesterone receptor [ER/PR]-positive and human epidermal growth factor receptor-2 [HER2]-negative), luminal B (ER/PR- positive and HER2-positive), HER2 (ER/PR-negative and HER2-positive), and triple negative (ER/PR- and HER2-negative) molecular subtypes. In this study we have also tried to correlate various molecular subtypes of breast cancer with age distribution, histological grade, lymph node status and distant metastasis. Methodology: We conducted a 5-year retrospective study on 547 patients. Clinical data including the age, sex, lymphnode status along with histological type and, grade of the tumour were recorded and the cases were subjected for immunohistochemical evaluation of HER-2/neu, ER, PR receptor status. Results: The results showed that HER2 neu was the most predominant immunomarker, while ER and PR was almost half of it. Among the molecular sub typing HER 2 type was the most prevalent constituting 53% of the cases, followed by almost triple negative and luminal A subtype with 20% cases each. Luminal B was least frequent with 9% of the cases. An inverse relationship exists between expression of her 2 neu and ER/PR. Conclusion: Our study concluded that molecular subtyping of breast carcinoma is an important part of complete histopathology report, in terms of prognosis, recurrence and treatment. A shift in occurrence of breast malignancies towards younger age leads to increased Her-2 neu expression.

A Rare Case of Primary Peritoneal Psammocarcinoma Presenting as Acute Intestinal Obstruction and Ascites

We report a rare case of primary peritoneal psammocarcinoma (PPP) in a 60year old female patient who presented to surgical emergency with complaints of inability to pass feces and flatus for last 3 days along with pain and distension of abdomen. On clinical examination there were features of acute intestinal obstruction. Contrast CT of abdomen was suggestive of intestinal obstruction along with a stricture at the recto-sigmoid junction. On exploration there was a growth compressing the recto-sigmoid junction from the serosal surface. Anterior resection of the recto-sigmoid was done with negative gross margins. Histopathological examination of the resected specimen led to a diagnosis of primary peritoneal psammocarcinoma because of a solitary peritoneal lesion having abundant psammoma body formation and normal ovaries visualized on radiology and per-operatively. The diagnosis was further confirmed by histochemical tests and immunohistochemistry along with normal CA-125 levels in the patient.

Complete Resolution of Bilateral Pulmonary Hydatid Cysts with Prolonged Administration of Albendazole: A Rare Occurrence

Hydatid disease is a zoonotic disease caused by Echinococcus species. Echinococcus granulosus is the most common species which is responsible for hydatid disease in the humans who act as accidental intermediate hosts in the life cycle of the parasite. Pre-operative albendazole therapy followed by surgery is the mainstay of treatment for pulmonary and hepatic hydatid cyst at present. Not much data is available to support the sole use of albendazole for complete cure apart from its usage for those patients who have refused surgery or cannot undergo surgery because of any reason. We hereby report the case of a 12 year old female patient who was diagnosed with bilateral pulmonary hydatid cysts that responded well to Albendazole 15mg/kg /day given for a period of nine months with a drug free interval of one week every month. There was complete clinical and radiological resolution of hydatid cyst after the treatment. There has been no recurrence on follow-up of one year.

Gossypiboma: To Err is Human – A Case Report

Gossypiboma (retained surgical sponge) is one of the identities that can be a disaster not only to the carrier of operating surgeon but also for the hospital as far as the financial burden and the reputation is concerned. The patient may have severe morbidity and in worst of the event can have mortality. The aim of this article is to highlight the fact that the incidence is not as rare as has been reported in different literatures and to discuss its various –clinico-radiological features, predisposing factors, measures to avoid it and how to manage when such a calamity has occurred. This article increases the awareness about the problem thus avoiding unnecessary morbidity/mortality to the patient as well as save the surgeon from malpractice law suits, great psychological trauma and negative publicity.

Mixed Medullary and Papillary Carcinoma Thyroid in a Young Female- A Rare Case Report

The medullary thyroid carcinomas (MTC) comprise 5-10% of all thyroid carcinomas. It is known to show many cyto-architectural variations. The WHO classification of thyroid tumors includes an entity called mixed medullary-papillary carcinoma, a rare malignancy known to represent <1% of all thyroid malignancies. Fewer than 40 such cases have been reported so far and include tumors showing morphological features of both medullary carcinoma and papillary carcinoma with immunoreactivity for calcitonin and CK19 &thyroglobulin respectively. We report a case of a 27-year-old female with complaints of gradually increasing neck swelling for 2 years, with difficulty in swallowing in the last 2 months. The swelling was more localized towards left. Ultrasound neck revealed a nodule in the left lobe of thyroid with benign features most likely nodular colloid goiter. Thyroid profile of the patient was normal. FNA revealed sheets and follicles lined by both hyperplastic and involutional follicular cells. Few micro follicles showed pleomorphic cells having hyperchromatic nuclei and mild anisonucleosis. A diagnosis of colloid goiter was given on cytology; however, on grounds of suspicion of a neoplastic process, histopathology was advised. The patient underwent total thyroidectomy. Hematoxylin & Eosin stained sections showed features of mixed medullary-papillary carcinoma of the thyroid which was further confirmed on Immunohistochemistry and raised serum calcitonin levels. It is important to know about this entity due to its prognostic implications, association with other endocrine disorders and to prevent any diagnostic dilemmas.