Synchronous Renal Cell Carcinoma Metastasis Masquerading as Subcutaneous and Thyroid Swellings, Diagnosed on FNAC- A Case Report

Renal cell carcinoma (RCC) is one of the most aggressive genitourinary cancers accounting for about 3% ofadult malignancies. The most common symptoms at the time of presentation are hematuria, lion pain and/oran abdominal mass. However, about a quarter of patients with RCC present with metastatic disease; withlungs, lymph nodes and bone as prototypical metastatic sites. RCC notoriously may metastasize to bizarrelocations like subcutaneous tissue and thyroid. We report a case of simultaneous subcutaneous and thyroidsynchronous metastasis of RCC in an 80year old female diagnosed on FNAC.

A Study into the Patterns of Gastrointestinal Tract Polyps.

The study was retro-prospective in nature. 102 cases diagnosed during the period of 10 years (i.e. 2003 to 2013) were studied. The site, age and sex wise distribution of the polyps was analyzed. Of 102 cases, 64(62.75%) were males, 38(37.35%) were females. The age ranged from 2 to 80 years with a mean of 27.2 years, maximum cases were seen in 0-9 years i.e. 39(38.24%). 88(86.27%) cases were benign and 14(13.73%) were malignant. Commonest site involved was colorectal region (78.43%). Hematochezia was seen in 48 cases (65.75%). Histologically 91 (89.2%) were epithelial polyps, 7 (6.9%) non epithelial polyps and 4(3.9%) miscellaneous polyps. The commonest epithelial polyp was juvenile polyp (49 cases) followed by adenomatous polyp (14 cases). Low grade dysplasia seen in 11(78.57%) and high grade dysplasia was seen in 3(21.43%) adenomatous polyps. Study provides an insight into histological patterns of GI polyps and enhances our knowledge about vivid etiologies of these polyps. Many of these polyps are precursors to malignant disease, it is recommended that endoscopy with polypectomy and histological confirmation is necessary to confirm the diagnosis followed by continued surveillance in patients having dysplastic polyps.

A new focus of cutaneous leishmaniasis in Jammu division of Jammu and Kashmir State, India.

Background: Cutaneous leishmaniasis in India is mainly confi ned to the deserts of Rajasthan; some cases have been reported from the dry north-western half of the Indo-Gangetic plain, including Punjab, Himachal Pradesh, Delhi and Varanasi. Aims: To highlight a new focus of cutaneous leishmaniasis in the Jammu division of Jammu and Kashmir State, previously a non-endemic area. This report presents the clinico-epidemiological and investigative results of 120 new cases of cutaneous leishmaniasis detected between November 2012 and October 2013. Methods: The clinical diagnosis of cutaneous leishmaniasis was made using criteria proposed by Bari and Rahman. It was further confi rmed by the demonstration of Leishman-Donovan bodies in Leishman stained slit skin smears and skin biopsy specimens, and/or by a satisfactory response to intra-lesional sodium stibogluconate given weekly for 4 weeks. Serial clinical photographs were taken before giving injections and at the end of the 6th week. Results: There were 67 females and 53 males with an age range of 8 months to 80 years. The most frequently affected site was the face. Lesions were most commonly of the nodulo-ulcerative type. The number of lesions ranged from 1 to 4. Farmers (28.1%), homemakers (27.2%) and students (27.2%) were signifi cantly over-represented among the occupations (P < 0.001). Skin smears and biopsies were positive for Leishman-Donovan bodies in 50.8% and 44.2% cases, respectively. Conclusions: There is a new focus of cutaneous leishmaniasis in Jammu division which deserves urgent attention from the public health angle. Further epidemiological studies are warranted to establish the identity of the vector and the strain of Leishmania involved.

To Evaluate The Usefulness of Cytological Grading of Breast Cancer as a Predictor of Lymph Nodal Metastasis.

In a 5-year retrospective and 1-year prospective study a total of 110 fine-needle aspiration cytology (FNAC) cases of breast cancer were studied. These were graded according to Robinson's and Mouriquand's grading methods and relationship between grading and lymph node metastasis; cell dissociation parameter of Robinson's grading and lymph node metastasis evaluated. Of the 110 cases graded by Robinson's method, Grade I tumours had lymph node involvement in 3.57% of cases. Grade II and Grade III tumours had lymph node involvement in 6.52% and 47.22% of cases respectively where as when graded by Mouriquand's method, Grade I tumours had lymph node involvement in 3.57% of cases. Grade II and Grade III tumours had lymph node involvement in 7.14% and 42.5% of cases respectively. Although both grading systems showed significant relationship with lymph node involvement but Robinson's grading was a much better predictor of lymph node metastasis. Our study showed that greater cell dissociation was associated with higher incidence of regional lymph node metastasis. A highly significant relationship was observed between cell dissociation and lymph node involvement (p=0.00000). We conclude that cytological grading of breast cancers is a strong predictor of lymph nodal metastasis and greater cell dissociation is associated with higher incidence of regional lymph node metastasis.

Kaposi Sarcoma Presenting as an Index Sign of HIV Infection in an Indian.

A -38 year old, married man presented with multiple asymptomatic livid reddish brown plaques, papules over lateral side of left ankle and dorsum of left foot along with difficulty in walking for last six months. Histopathological examination of biopsy from the lesion showed a Kaposi's sarcoma (KS). Subsequently, his serology for the HIV viruses was done and found to be positive for HIV-1.

Multicentric Lupus Vulgaris.

A eight year old girl presented multiple plaques of lupus vulgaris, numerous papules of lichen scrofulosorum and involvement of right ulnar bone. The patient responded to antituberculosis therapy. The multiple foci were probably due to hematogenous dissemination

Idiopathic Tumoral Calcinosis With Unusual Presentation Involving Small Joints: Presentation of 4 Cases With Review of Literature.

Tumoral calcinosis is a rare familial disorder characterized by tumour like masses of calcification, usually in the soft tissues around large joints (para-articular). Masses of calcification sometimes cause gross deformity and disabilities requiring extensive surgical intervention. Involvement of distal joints like that of hand and feet is extremely rare. We present a series of 4 cases of tumoral calcinosis, two of them with unusual presentation involving great toe and thumb.

Rosai-Dorfman Disease.

Rosai-Dorfman Disease (RDD) or Sinus Histiocytosis with massive lymhadenopathy (SHML) is a rare, benign proliferative disorder of histiocytes, sometimes showing familial incidence. It is mainly characterized by painless bilateral cervical lymph node enlargement and is often associated with fever and leucocytosis. It presents in the first or second decades of life, though any age group can be affected. Without the awareness about RDD, the diagnosis of RDD is unexpected especially in South East Asian Countries where certain lymphadenopathies such as tuberculosis, metastatic nasopharayngeal carcinoma and lymphomas are common. RDD is commonly missed and so its revision would seem worthwhile, this case illustrating the disappearance of the lymphadenopathy without treatment.

Metastatic Squamous Cell Carcinoma of The Cervix Presenting As A Splenic Cyst.

Squamous cell carcinoma metastatic to the spleen is a rare occurrence and has been reported mostly in autopsy series. Only two cases of carcinoma cervix with solitary metastasis to the spleen have been reported in living patients. Among these, the tumour was confined to the spleen in only one case, where as in the other it had extended to involve the pancreas and the left kidney and adrenal. We present a case of a 50 year old patient with carcinoma cervix, treated with radiotherapy in 1997. Four years after completion of primary treatment, she presented with a painful mass in the left hypochondrium. Exploratory laparotomy revealed a splenic cyst which on pathological examination was diagnosed as metastatic squamous cell carcinoma. The patient received chemotherapy and was alive four years later, at the time of writing of this report.

Lymphangiectasia of small intestine presenting as intussusception.

Intussusception is defined as telescoping of a segment of gastrointestinal tract into an adjacent one. In small children, it is the commonest cause of intestinal obstruction. More than 90% of childhood intussusceptions are idiopathic. We report a rare case of localized small intestinal lymphangiectasia, presenting as intussusception in a 6-month-old male child. The child presented with features of acute intestinal obstruction for which he was later operated. The gross examination of excised ileocecal mass revealed intussusception. Histopathologic examination revealed lymphangiectasia of small intestine, which acted as a lead point for ileocecal intussusception. Postoperative period was uneventful.

Inflammatory Fibroid Polyp of Ileum

Inflammatory fibroid polyps are uncommon but well documented solitary polypoid lesions occurring in gastrointestinal tract ; most commonly in stomach followed by ileum and rarely in colon ,duodenum and oesophagus. Polyps in ileum most commonly present with acute intestinal obstruction as aresult of intussusception. The lesions are characterized by variable proliferation of fibroblasts and small vessels which may involve the whole thickness of the bowel wall .Mast cells and Eosinophils are also seen in the polyp.

Gouty Polyarthritis-An Uncommon Presentation

Crystal arthropathies are a group of disorders produced due to deposition of crystals in and around joints. These are usually monoarticular, but some 10% of the patients with mono sodium urate crystal arthropathy (Gout) can be polyarticular. However, in present set up with much advancement in diagnostic and therapeutic modalities, the number of patients of gout with polyarticular involvement is less common. Here we present a case of gouty polyarthritis with a prolonged intercritical period.

True Carcinosarcoma of the Parotid Gland

True malignant mixed tumours (carcinosarcoma) of the salivary gland origin are very rare and demonstrate both malignant epithelial and stromal components. We report a case of parotid gland carcinosarcoma which showed foci of squamous cell carcinoma and chondrosarcoma without a clinical or histological evidence of pre-existing pleomorphic adenoma.

Squamous Cell Carcinoma of the Conjunctiva

A rare case of squamous cell carcinoma of the conjunctiva is presented here. This highlights the significance of aggressive management of such cases surgically and the use of adjuants per operatively to prevent recurrence.

Primary Adenocarcinoma of Appendix Presenting as Omental Metastasis

The adenocarcinoma of appendix is a rare entity The patients present usually with symptoms of appendicitis, a palpable abdominal mass or rarely as a complication of pseudomyxoma peritonei, We report a case who presented with lump abdomen and ascitis and revealed a tiny infiltrative growth at the base of appendix at laparotomy.

Sympathetic Ophthalmia: Mangement and Role of Immunosuppressants.

Presented here is a case of sympathetic ophthalmia that provided us an opportunity to evaluate the eficacay of immunosuppressive drugs with steroids in reduced doses and their outcome in improving thevisual loss in a young patient who had fast deterioration in his visual acuity.

Gorlin's Syndrome-A case report.

Gorlin's syndrome is a rare disorder transmitted as an autosomal dominant trait. Most common phenotypic expression of this syndrome is a basal cell carcinoma (BCC). It is characterized by multiple skin lesions on head and neck region. We present a case of49 year old male who presented with basal cell carcinoma at multiple sites simultaneously.

Pneumatosis Cystoides Intestinalis.

Pneumatosis cystoides intestinalis is a rare condition. Presented here is a case report of a patient who was admitted with acute abdomen and was operated upon. The gross morphology and histological features of the specimen were consistent with Pneumatosis cystoides intestinalis.

Wegener's Granulomatosis Presenting as Nasal Polyp.

Wegener`s granulomatosis (W G) is characterised by aseptic granulomatous inflammation and vasculitis which classically affects kidneys, upper and lower respiratory. Although majority of patients present with saymptoms of head and neck region, rarely this region is the sole site of involvement. The interpretation of biopsy for the diagnosis of this diseae precision. We report a case who presented clinicslly as nasal polyp. However, the microscopy confirmed the diagnosis of WG.