Autoimmune oophoritis: A rarely encountered ovarian lesion.

Autoimmune oophoritis is a rare disorder causing ovarian failure clinically characterized by amenorrhea and infertility. It often occurs in a setting of autoimmune polyendocrine syndromes. A 38-year-old female presented with a 3 years history of secondary amenorrhea. She was on treatment for Hashimoto’s thyroiditis and Addison’s disease. The ovaries were cystic and histologically featured by folliculotropic lymphoplasmacytic infl ammatory infi ltrate concentrated in the theca interna layer of developing follicles, but sparing the primordial follicles.

Cytomegalovirus colitis masquerading as rectal malignancy in an immunocompetent patient.

Gastrointestinal tract (GIT) involvement by cytomegalovirus (CMV) infection is well-recognized in immunosuppressed patients but is uncommon in immunocompetent hosts. The colon and esophagus are the most frequently affected sites with punched out ulcers being the characteristic mucosal lesion. CMV-induced pseudotumor is an exceptionally rare presentation, especially in immunocompetent hosts. A 76-year-old immunocompetent female presented with abdominal pain and constipation. Colonoscopy revealed an ulcerated polypoidal tumor-like mass in the anorectal region. Biopsy of the lesion showed large basophilic intranuclear inclusions which were positive for CMV on immunohistochemical staining. The patient responded to 2 weeks of antiviral therapy with complete resolution of the mass. Although rare, pseudotumors associated with CMV infection should be considered in the differential diagnosis of tumorous lesions of the GIT.

Benign signet ring cells in pseudomembranous colitis: A diagnostic trap.

A 71-year-old female patient was admitted with intractable diarrhea and abdominal distention following several courses of broad spectrum antibiotic therapy. Colonic biopsy revealed pseudomembranous colitis with foci of signet ring cell (SRC) change. The SRCs possessed bland nuclei and were confi ned to the basement membranes of the crypts with no infi ltration into the lamina propria. Benign SRCs in pseudomembranous colitis is an uncommon phenomenon. Awareness of this rare, but potential pitfall is of utmost importance to avoid a misdiagnosis of SRC carcinoma.

Primary osteogenic sarcoma of the breast.

Primary osteogenic sarcomas of the breast are extremely rare with less than 100 cases reported in literature. They generally present in middle aged and older women and are highly aggressive. These tumors need to be differentiated from osteoid/bone- producing metaplastic carcinomas as the two differ in their biologic behavior and treatment protocols. A 60-year-old lady presented with a short history of a rapidly enlarging breast lump. Histopathogical examination revealed a richly cellular, pleomorphic tumor with abundant osteoid. The tumor cells were immunoreactive for vimentin and negative for cytokeratin and estrogen and progesterone receptors.

Serous microcystic adenoma (glycogen rich cystadenoma) of the pancreas.

Serous microcystic adenoma (SMCA) is a rare pancreatic tumor with a striking predilection for elderly females and a rather unique morphology. Classically, the tumor is riddled with innumerable small cysts around a stellate scar. The quintessential histological features are closely placed small cysts lined by glycogen rich cuboidal epithelium. In view of its excellent prognostic outcome, this tumor needs to be accurately diagnosed. This report documents a case of SMCA occurring in a 60-year-old female.

Long segment ileal duplication with extensive gastric heterotopia.

Duplications of the alimentary tract are rare congenital anomalies which can be found at all levels of the alimentary tract. Majority of the duplications present as spherical cysts and usually range from a few millimeters to less than ten centimeters in size. Duplications produce complications such as intestinal obstruction or hemorrhage. A two-month-old infant presented with recurrent episodes of bleeding per rectum. Laparotomy revealed a giant ileal duplicated bowel segment which exhibited extensive gastric heterotopia with focal ulceration.

Placental site nodule: a tumor-like trophoblastic lesion.

Placental site nodule is an uncommon, benign, generally asymptomatic lesion of trophoblastic origin, which may often be detected several months to years after the pregnancy from which it resulted. This entity may have bizarre histologic findings and should be distinguished from other aggressive lesions like placental site trophoblastic tumor, epithelioid trophoblastic tumor and squamous cell carcinoma.

Transfusion associated GVHD.

Transfusion-associated graft-versus-host disease (TA-GVHD) is an under-diagnosed condition in clinical practice. It can occur in immunocompromised as well as immunocompetent hosts and may follow allogeneic bone marrow transplant or transfusion from a related donor. The clinical course is stormy with a high mortality rate. Avoiding the use of blood transfusions from related donors and irradiation of blood products can prevent graft versus host disease. A case of graft versus host disease following related donor transfusion is presented here.

Collagenous micronodules in prostatic adenocarcinoma--a case report.

Collagenous micronodules are a rare but diagnostically valuable feature seen in association with prostatic adenocarcinomas. Herein we report a case of adenocarcinoma prostate associated with abundant collagenous micronodules.

Presacral carcinoid tumour arising in a tailgut cyst--a case report.

Primary carcinoid tumours of the presacral region are extremely infrequent with just a handful of such cases reported in literature. Tailgut cysts(retrorectal cystic hamartoma) are also very uncommon lesions which are usually identified in adult life. They are developmental abnormalities and consist of multiloculated cysts lined by squamous, transitional or glandular epithelium. Malignant transformation within tailgut cysts is rare; the tumours which arise include carcinoid tumours and adenocarcinomas. We report the unusual occurrence of a carcinoid tumour developing within a tailgut cyst.

Paraganglioma of the urinary bladder--a case report.

Paragangliomas of the urinary bladder are extremely rare tumors accounting for less than 1% of all bladder tumors. Males and females are affected roughly equally with an average age of 41 years. Hypertension and headache during or immediately after voiding in association with intermittent hematuria is virtually diagnostic of urinary bladder paragangliomas. A high index of clinical suspicion is required to diagnose these tumors. We present a case of a urinary bladder paraganglioma because of its rarity.

Necrotising prostatic granulomas following transurethral resection--a case report.

Necrotising post surgical granulomatous prostatitis following transurethral resection of the prostate is a poorly recognized entity. It is often mistaken for other conditions like tuberculosis, allergic granulomatous prostatitis, etc. This case is being reported in order to increase the awareness of this condition. The relevant literature has also been reviewed.

Amyloid goitre: a case report.

Amyloid goitre is an exceedingly rare condition associated with a clinically apparent enlargement of the thyroid gland due to massive amyloid infiltration. We hereby report an additional case of this rare entity.

Conjunctival impression cytology in contact lens wearers.

PURPOSE: To evaluate the cytological changes in conjunctiva following regular contact lens wear and to determine the correlation, if any, between severity of cytological alteration and symptoms related to contact lens wear. METHODS: One hundred eyes (50 normal asymptomatic subjects) who served as a control group were studied by conjunctival impression cytology (CIC). These subjects were fitted with rigid gas permeable (RGP) or soft contact lenses and were followed up at the end of 3 and 6 months. At each follow-up visit the CIC was repeated. A filter paper with the impression specimen was stained with periodic acid schiff (PAS) and haematoxylin stain to study goblet cell loss. Papanicolaou stain was done to study squamous metaplasia. The cytological changes were graded using the system described by Natadisastra et al. RESULTS: Severity of cytological changes increased with the duration of contact lens wear (P = 0.00001). At the end of 6 months, 60% of symptomatic eyes wearing soft contact lens and RGP lens showed abnormal CIC changes. None of the asymptomatic RGP contact lens wearing eyes showed abnormal CIC changes whereas 33.4% of the asymptomatic soft contact lens wearing eyes showed abnormal CIC changes (P = 0.033). Epithelial changes occurred within 3-6 months of contact lens fitting. CONCLUSION: Severity of cytological changes increased with duration of lens wear (P = 0.00001). Prevalence and severity of cytological alteration is more in symptomatic contact lens wearers. Soft contact lens wearers although asymptomatic showed severe CIC changes.