Tailgut cyst: An uncommonly diagnosed common entity - A case report and review of literature.

Tailgut cysts (TGC) though relatively common are rarely diagnosed and documented. Most of the times, they are misdiagnosed and mismanaged. When malignancy develops in TGC it is rarely attributed to it as it is undiagnosed earlier and later on there may not be any evidence left behind. We report one such case which was diagnosed though not preoperatively. Review of literature reveals only few such cases after the initial description by Hjermstad and Helwig in 1988. Surprisingly most of the reports especially the larger case series are by radiologists. Surgeons and pathologists have contributed very few cases. This case report is aimed at increasing the awareness about this entity so that it will be suspected, investigated properly and treated before development of complications like recurrent fistulae, ischioanal abscesses which increase the morbidity and life threatening complications like malignant change.

Interobserver reproducibility of Gleason grading of prostatic adenocarcinoma among general pathologists.

Context: Gleason grade is the most widely used grading system for prostatic carcinoma and is recommended by World Health Organization. It is essential that there should be good interobserver reproducibility of this grading system as it has important implications in patient management. Aim: To assess interobserver reproducibility of Gleason grading of prostatic adenocarcinoma. Design: A total of 20 cases of prostatic adenocarcinoma were scored using Gleason grade by 21 general pathologists. The scores were then compared using κ-coefficient and consensus score. Results: For Gleason score groups (2-4, 5-6, 7 and 8-10) overall agreement with consensus score was 68%. Exact agreement for Gleason scores with consensus score was 43.3% and 92.3% within ±1 of the consensus score. κ coefficient for primary grade ranged from -0.32 to 0.92 with 60% of the readings in fair to moderate agreement range; and for secondary grade κ ranged from -0.30 to 0.62 with 78% of the readings in slight to fair agreement range. Kappa for Gleason scores ranged from -0.13 to 0.55 with 80% of the readings in slight to fair agreement range; and for Gleason score groups κ ranged from -0.11 to 0.82 with 68.5% of the readings in fair to moderate agreement range. Conclusions: In our study interobserver reproducibility of Gleason scores among general pathologists was at lower level and it highlights the need to improve the observer reproducibility by continuous educational sessions and taking second opinion in cases where grade could significantly influence management.

Plasma levels of genistein following a single dose of soy extract capsule in Indian women.

BACKGROUND & OBJECTIVE: Soy isoflavones are being used as therapy for menopausal syndrome in many countries. Marketed preparations show variability in bioavailability and there are variations in kinetics due to ethnicity and diet. Inspite of soy isoflavone being available in the Indian market there are no studies to show whether the preparation is likely to be effective in women. This study was carried out to determine circulating levels of genistein, a bioactive soy isoflavone, in Indian women after a single dose of soy extract. METHODS: Six healthy vegetarian women volunteers, between 36 and 62 yr and with a mean body mass index (BMI) 25.01+/-2.02 (kg/m2), were enrolled after an informed consent. Women with antibiotic or Soy food intake within 1 month of study were excluded. A single dose of standardized soy extract capsule containing 64.12 mg of total isoflavones (genistein content equivalent to 31.76 mg) was ingested under supervised fasting condition and multiple blood samples were collected at 0, 1, 2, 4, 6, 8 and 24 h. Genistein levels were measured by high performance liquid chromatography (HPLC) method with a detection level of 2.5 ng/100 microl of injection volume. The intra- and inter-assay coefficients of variation were < 5.32 per cent. RESULTS: Genistein was detected (10.3 to 16.2 ng/ml) in 3 volunteers in baseline samples. Within one hour genistein levels rose from 42 ng to 215 ng/ml with a maximum concentration of 117 to 380 ng/ml at 4 to 8 h. A secondary peak suggestive of enterohepatic circulation was seen between 4 and 6 h in 2 out of 6 volunteers. The mean Cmax was 315.5 +/- 57.1 ng/ml. All women had detectable levels from 25.2 to 109.3 ng/ml at 24 h. INTERPRETATION & CONCLUSION: Our study showed adequate circulating levels of genistein in Indian vegetarian women after a single dose of soy extract. Variability in plasma levels of the soy isoflavones may explain differences in responses to therapy.

Stromal luteoma: report of a rare case.

Steroid cell tumours (SCTs) account for less than 0.1% of all ovarian tumours. Three major categories ofSCTs include (1) stromal luteoma, (2) steroid cell tumour not otherwise specified and (3) Leydig cell tumours that do not have another component. Stromal luteomas constitute 20% of SCTs. They usually occur in postmenopausal women and about 60% present with estrogenic manifestations. We report a case of stromal luteoma in an elderly lady who presented with postmenopausal bleeding secondary to endometrial hyperplasia. An interesting finding in our case was the presence of many eosinophilic hyaline globules scattered throughout the tumour, the significance of which remains to be determined.

Superficial extension of squamous cell carcinoma in situ of cervix involving endometrium, bilateral fallopian tubes and ovaries: a case report.

Although squamous cell carcinoma of the cervix is the commonest gynaecological malignancy in India, squamous cell carcinoma of the endometrium is rare. Direct extension from the cervical growth can involve the uterine corpus but superficial spread without invasion of the underlying myometrium is uncommon. We report a case of squamous cell carcinoma in-situ of the cervix with superficial extension to the endometrium and both fallopian tubes with simultaneous involvement of both the ovaries.

Inflammatory pseudotumour of liver--a case report.

A rare case of inflammatory pseudotumour of liver in a child is reported. The child presented with obstructive jaundice and was considered to have malignant tumour of liver clinically and by imaging modalities. Resection of left hepatic lobe with the mass was done. Histologically, the lesion consisted of an admixture of proliferation of lymphocytes, plasma cells and fibroblasts along with vasculitis and variable amount of hyaline fibrosis. Adjacent liver showed evidence of biliary cirrhosis and multiple microabscesses. Many of the previously reported cases were also diagnosed clinically and radiologically to be malignant tumours of liver. The case is reported to create awareness of this rare entity.