Uncommon plasmacytoid myoepithelioma originating from ectopic minor salivary gland in neck: a rare case with rare site presentation

The aim of this case report is to present as case of plasmacytoid at ectopic minor salivary gland in the neck which is a rare neoplasm with uncommon presentation of site. Usually it is a tumor of major salivary gland and more common in parotid gland and less common in the minor salivary gland of the oral cavity predominantly in palate. Here authors are discussing a case of 10-year-old female who presented in our institute with complain of swelling over right mid cervical region which was clinically suspected as reactive cervical lymph node. Patient was evaluated further and cytologically diagnosed as a case of plasmacytoid myoepithelioma. It was also confirmed as a case of plasmacytoid myoepithelioma after histopathology and immunohistochemistry studies. Plasmacytoid myoepithelioma at ectopic minor salivary gland site in the neck is uncommon presentation and only a limited number of cases have been reported in literature.

A comparative evaluation of bone marrow biopsy and bone marrow aspiration in different haematological condition with special reference to leukaemia and lymphoma

Background: For diagnosis of haematological disorders there are three modalities to examine bone marrow, bone marrow aspiration cytology (BMA), bone marrow imprint (BMI) and bone marrow biopsy (BMB). BMA gives cytological picture; BMI also gives cytological picture but cells are less in number and BMB gives cytological as well as architectural picture. BMA alone may not be sufficient to reach diagnosis therefore the present study was undertaken to compare the above modalities. The study was conducted with the aim to perform cytomorphological evaluation of bone marrow in various haematological disorders with special reference to leukaemia and lymphoma and to compare bone marrow aspiration smears with bone marrow trephine biopsy.Methods: The present study was conducted in department of pathology, LLRM Medical College, Meerut inpatients attending the outpatient department and in-patient department of pediatrics and medicine of SVBP Hospital attached to LLRM Medical College, Meerut, over a period of one year i.e. from March 2018 to May 2019. A detailed clinical history, physical examination and laboratory examination of all the cases was done.Results: Out of 50 cases, maximum number of cases were of anemia 26/50 (52%) followed by leukemia 17/50 (34%), lymphoma 5/50 (10%), multiple myeloma 1/50 (2%), myelofibrosis 1/50 (2%), leishmaniasis 1/50 (2%) and idiopathic thrombocytopenic purpura 1/50(2%). BMA smears were compared with biopsy and concordance and discordance was established. The overall diagnostic accuracy of aspiration was 94%.Conclusions: Bone marrow examination is a safe, quick easy and cost-effective procedure with very less patient discomfort. BMA shows better cellular details when compared to BMI and BMB. BMB is diagnostic investigation in dry tap cases like aplastic anemia, myelofibrosis, myelodysplastic syndrome and metastatic tumors. In present study, concordance between BMA and BMB was seen in majority of the cases and diagnostic accuracy was 94% study concludes that bone marrow aspiration cytology and trephine biopsy complement each other and should be performed simultaneously for complete bone marrow work up and evaluation.

Signet ring cell cholangiocarcinoma in a patient previously operated for cholecystectomy: is there any connecting link?

Cholangiocarcinoma are malefic tumours of bile duct. Signet ring cell carcinoma (SRCC) is rare entity. Several risk factors have been attributed to its ethology, the main overriding link between two being chronic inflammation of the bile system. Cholecystectomy has also been a proposed risk factor. This study was undertaken in Department of Pathology at LLRM Medical College, Meerut. A 49 years old female, operated for cholecystectomy 1.5 year back in same hospital, now presented with chief complains of jaundice and abdominal discomfort. The blood chemistry revealed increased total bilirubin (13.7 mg/dl), Alkaline phosphatase (877.6 IU/L), Carbohydrate Antigen (CA) 199(184 U/ml) and Carcinoembryonic antigen (CEA) (14.5 ng/ml). Computed Tomography (CT) showed a stricture in mid Common bile duct (CBD). Excision of stricture was done using retrocholic hepatico-jejunostomy. Tissue was submitted for histopathology. Histopathological assessment showed SRCC. The patient failed to turn up for further management but returned back after a span of time presenting with gross ascites and pallor ultimately leading to death within 12 weeks of diagnosis. This was the first case of SRCC to arise in a patient who had a previous history of cholecystectomy. Whether there is some connecting link between the two is still not clear. Further studies are warranted in this direction to establish cholecystectomy as an etiological factor for cholangiocarcinoma.

Cardiovascular disease in pregnancy

Background: Maternal cardiac disease is a major cause of non-obstetric maternal morbidity and mortality. The care of pregnant women with cardiac disease requires a multidisciplinary approach, involving obstetricians, cardiologists and anesthesiologist.Methods: A prospective analytical study of maternal heart disease and its fetomaternal outcome is carried out in the department of obstetrics and gynecology at tertiary hospital and teaching institute. The study was carried out on 50 cases belonging to age group 18-50 years with various cardiac diseases during their pregnancy and peripartum period.Results: In this study, 78% of the cases were registered with our hospital. The present study shows about 32% of the women having cardiac disease were in the age group of 20-25 years. 34% belonged to NYHA class II and had a relatively uneventful peripartum period. Among all forms of heart disease, RHD was common constituting 26% of cases. Most common condition associated with cardiac disease in pregnancy was preeclampsia (36%) in our study, with anemia being other one (10%). The common complications were congestive cardiac failure (12%) and pulmonary edema (8%). Combination of diuretics and beta blockers was used most commonly (22%). 56% of women delivered with caesarean section. 42 patients delivered after age of viability with 29 (69%) term deliveries and 13 (30%) preterm deliveries with 8 requiring NICU care.Conclusions: Valvular heart disease of rheumatic origin is the most common cardiac disease associated with pregnancy.The availability of adequate systems of early diagnosis of cardiac lesion, reference to tertiary care center & close monitoring of patient and delivery with multidisciplinary approach include specialized cardiologic care, high risk obstetric support and neonatology expertise that can minimize the serious consequences and helps to improve fetomaternal outcome. Pre-conceptional counseling and surgical correction of certain conditions improves maternal as well as fetal outcome. Awareness needs to be created about heart diseases during pregnancy and the importance of regular antenatal check-ups.

Clinicopathological study of benign and malignant ovarian tumours and the role of HER2/neu and ER expression in these tumours

Background: Ovarian cancers represent the 6th most common cancer among females and are the most common cause of death from gynaecological cancers in the world. The aim is to do clinicopathologic study of ovarian tumours along with evaluation of the expression of estrogen receptor (ER) and human epidermal growth factor receptor (HER2/neu).Methods: A total of 85 cases of ovarian tumors were studied and immunohistochemistry was performed with specific antibodies against ER and HER2/neu as per standard protocol.Results: In present study, surface epithelial tumours were the commonest type comprising 64 cases (75.2%), followed by Germ cell tumours, 17cases (20%) and sex cord stromal tumours, 04 cases (4.8%).Among the surface epithelial tumours , ER‑positive cases were higher in malignant (71.4%) tumours as compared to borderline tumours (33.3%) and benign tumours (7.7%) while Her2/neu positive cases were higher in borderline (66.7%) tumours as compared to malignant tumours (42.9%) and benign tumours (15.3%).Among the germ cell tumours, ER expression was positive in 62.5% cases of mature teratoma while HER2/neu expression was positive in only 12.5% cases of mature teratoma. None of the sex cord stromal tumours showed positive expression of ER and HER2/neu.Conclusions: Positive expression of estrogen receptors is seen predominantly in surface epithelial malignancies and in mature teratoma. It proves the mitogenic role of estrogen in ovarian tumours. Her-2 neu was expressed mainly in malignant tumours. This suggests their carcinogenic role. This also helps in differentiating borderline and malignant tumours.

Bilateral Krukenberg Tumor.

Adrenal Myelolipoma is a rare tumor that is benign in nature and unilateral. It is usually asymptomatic with just a few millimeters in size but they can grow over 30 cms becoming a life threat to the patient. This tumor is generally considered as a type of hormonally inactive neoplasm which is composed of variable amounts of mature adipose tissue and normal hematopoeitic elements. These may not account for extramedullary sites of haemotopoiesis and are not associated with any specific hematologic disorder. Rarely, Adrenal Myelolipomas occur in association with Adrenocortical Adenoma or Adrenocortical Carcinoma. We report a case of Adrenocotical Adenoma with Myelolipoma in a 35 year old female who presented with pain in the right upper abdomen. The radiological appearance resembled adrenocortical carcinoma. This case emphasize the importance of this combination as a pitfall in the correct diagnosis and management of patient with Adrenal mass.

Three siblings with multiform seizures: An unusual presentation of Doose syndrome.

Doose syndrome, or epilepsy with myoclonic–atonic seizures, is a rare electroclinical syndrome. It is important to distinguish it from related epilepsy syndromes such as Lennox Gestaut syndrome and Dravet syndrome. We report the occurrence of this disorder in three siblings born of a non-consanguineous marriage.

Fine Needle Aspiration Cytology of Lymphadenopathy in HIV-Infected Patients.

To study the Fine needle aspiration cytology of lymphadenopathy in HIV-infected patients.Aspiration of lymph nodes was done with a 21-23 gauge fine needle in 74 HIV positive patients with lymphadenopathy. The smears were routinely stained with Papanicoloau, May Grünwald Giemsa, and Modified Ziehl- Neelson stains. Periodic acid Schiff and Grocott's methanamine stain were used wherever necessary. The most common cytological diagnosis was tubercular lymphadenitis (38 cases) followed by reactive hyperplasia (22 cases) and acute lymphadenitis/abscess (8 cases). There was one case each of Non Hodgkin lymphoma and metastatic carcinoma. 4 cases had unsatisfactory aspirates. The cytological diagnoses were concordant with the histological diagnoses in 19 out of 20 cases in which subsequent biopsy was available. FNAC is a very useful tool in the diagnosis of enlarged lymph nodes in HIV-infected patients. It is a quick, inexpensive, outdoor procedure and suitable for developing countries like India. The technique has high diagnostic accuracy.