Bilateral giant adrenal myelolipoma: A rare scenario

Adrenal myelolipoma is a benign tumor-like growth, composed of mature fat cells and bone marrow elements. We report a case of a 44-year lady who presented with a complaint of pain in the abdomen. The only positive finding was contrast-enhanced computed tomography (CECT) whole abdomen, which was suggestive of heterogeneously enhancing hypodense lesion of size 130 mm × 105 mm with few calcifications and 103 mm × 75 mm with intralesional fat attenuation in right and left adrenals. Rest laboratory parameters were normal. Only a few cases so far have been reported for bilateral adrenal myelolipoma but what stands out in our case is its giant size and bilaterality, managed surgically without any complications.

Intramyofiber skeletal muscle invasion: An unusual pattern of muscle infiltration in breast cancer

Skeletal muscle infiltration in carcinoma is a rare entity. Intramyofiber skeletal muscle invasion is the rarest type of muscle infiltration. Here we present one such case of intramyofiber skeletal muscle invasion in a case of breast carcinoma.

Retiform hemangioendothelioma: An uncommon vascular neoplasm

Retiform hemangioendothelioma is a rare vascular neoplasm of intermediate grade, the diagnosis of which can be challenging. We report a case of 35-year-old man with swelling in the postauricular region. He had undergone FNAC which had revealed blood only. Microscopic examination showed narrow, arborizing, vascular channels resembling normal rete testis. Evidence of mitoses or cytological atypia were lacking. Immunohistochemistry showed diffuse and strong staining for CD34 along with CD31 positivity. Immunostains for D240 and GLUT1 were negative. A diagnosis of retiform hemangioendothelioma was made. Histologically, it should be distinguished from Kaposiform hemangioendothelioma, Dabska tumor, epithelioid hemangioendothelioma, and angiosarcoma.

Orchitis: An unusual presentation of polyarteritis nodosa

Polyarteritis nodosa (PAN), a systemic necrotizing vasculitis with multiorgan development, is generally restricted to the medium-sized muscular arteries. The varied initial clinical presentations of PAN can lead to a delayed diagnosis. We present the case of a middle-aged male patient who presented with an acute onset right-sided testicular pain as the initial clinical symptom with ischemic changes on ultrasonogram, thereby requiring orchiectomy. This was reported to be a case of tubercular epididymo-orchitis. On review, the biopsy revealed features of necrotizing arteritis as seen in PAN with fibrinoid necrosis and giant cells, thus highlighting the fact that vasculitis due to PAN may have a localized presentation at the time of diagnosis. PAN should be distinguished from other causes of epididymo-orchitis and other vasculitis lesions, the most common being tubercular etiology in the Asian population.

Role of therapeutic thoracentesis in tuberculous pleural effusion

Prevalence of tuberculous pleural effusion is very high in the Asian subcontinent but very few studies have come up from this part of the world about the course of recovery of pulmonary functions after institution of anti-tubercular therapy [ATT] and thoracentesis. To study initial lung function impairment, changes over time after institution of ATT and thoracentesis and residual abnormalities left at the end of six months of treatment. Randomized open level interventional study over two years in 52 patients at a tertiary level teaching hospital. The study population was divided into two equal groups, A [therapeutic thoracentesis] and B [diagnostic thoracentesis]. Spirometry, chest radiograph and ultrasonography of thorax were done initially and at each follow-up visit up to six months. Statistical analysis was done [P value < 0.05 considered significant]. Both groups were comparable initially. After six months none in group A and five patients in group B had minimal pleural effusion. During follow up, mean percentage predicted of FEV1 and FVC increased more in A than in B and the differences were statistically significant [P < 0.05]. Pleural thickening, initially absent in both groups, was found to be more in B as compared to A at subsequent follow-up visits and this was statistically significant [P < 0.05]. Thoracentesis should be considered in addition to anti-TB treatment, especially in large effusions, in order to relieve dyspnea, avoid possibility of residual pleural thickening and risk of developing restrictive functional impairment

Primary adenocarcinoma of bladder--A case report.

A 24 years old male presented with haematuria. Ultrasonography depicted an echogenic mass on bladder wall, where prostate showed normal echo characters. Cystoscopy revealed a large papillary growth involving lateral wall, neck of the urinary bladder and prostatic urethra. Punched biopsy showed features of adenocarcinoma. Radical cystectomy was performed and it was reported as a case of primary adenocarcinoma of the urinary bladder.

Endometrioid carcinoma of uterus and ovary.

A thirty-two-year-old married woman presented with pain abdomen and polymenorrhoea. Her uterus was bulky and one of the fornices was full. USG of abdomen revealed unilateral ovarian tumour associated with a mass in the uterus. Histopathological report revealed synchronous endometrioid carcinoma of the uterus and the ovary with morphological evidences in favour of independent primary carcinomas. With these perspectives the present case is reported where endometrioid carcinomas of uterus and ovary are two separate primary tumours.

Knowledge and attitude in relation to HIV/AIDS among in-service nurses of Calcutta.

Seventy-five senior nurses attending a workshop were surveyed with questionnaires and using two separate scales, their knowledge about transmission and precautionary measures, and their general attitude towards HIV/AIDS as well as willingness for patient-care were assessed. The nurses showed a satisfactory level of knowledge (mean percentage score 74.3), but misconceptions regarding disinfection and precautionary measures were present; 33% had overall negative attitudes and 24% unwilling to provide care for HIV-infected patients. Knowledge and attitude were positively correlated (r = .32). Knowledge deficits of some aspects of infection leading to fear of contagion and judgemental outlook towards HIV infection might lead to negative attitude impeding proper care. It is suggested that continuous in-service training be instituted to dispel misconceptions and to develop favourable and non-discriminatory attitude.

Interaction of organophosphorus insecticides phosphamidon & malathion on lipid profile & acetylcholinesterase activity in human erythrocyte membrane.

The organophosphorus insecticides phosphamidon and malathion were found to inhibit the activity of human acetylcholinesterase in vitro, in the human erythrocyte membrane. Lineweaver-Burk analysis indicated that the insecticide induced inhibition of acetylcholinesterase activity was uncompetitive in nature. The total lipid, cholesterol and phospholipid contents of erythrocyte membranes were reduced following phosphamidon and technical malathion treatment, while the level of lipid peroxidation was raised following malathion treatment.

Histopathological and immunological studies in a cohort of balanitis xerotica obliterans.

Balanitis xerotica obliterans consisting of 52 cases had been studied in the present series. This disease entity is an insidious sclerosing disease of unknown aetiology, affecting mainly the skin and mucous membrane of glans, prepuce and sometimes the fossa navicularis urethrae or even terminal urethra. Atrophic white patches on external genitalia and obstructive uropathy are two common presenting features. It has been classified as local form of lichen sclerosus et atrophicus. Poor local hygiene, circumcision and association of auto-immune diseases like vitiligo are responsible as suggested in this study. Routine tests detected associated cystitis in 8 cases, haematuria in 4 cases, non-reactive VDRL in all cases and impaired glucose tolerance in 5 cases. Immunoglobulin profile (39 cases) showed altered pattern, suggesting some chronic antigenic stimulation. Out of 33 cases where biopsy done, histologically proved typical balanitis xerotica obliterans was found in 19 cases. Malignant change was noted in one case only. Circumcision and dilatation offered temporary relief.

Effect of malathion on antioxidant defence system in human fetus--an in vitro study.

Malathion under in vitro condition even at lower concentration (250 ppm) altered the level of enzymes associated with glutathione cycle and antioxidant defence system in human fetal brain and liver. Such changes involved alterations in glutathione status and extent of lipid peroxidation. The inhibitory effect of malathion was dose dependent in case of human fetal brain and was more vulnerable than fetal liver. This alteration (inhibition or activation) was maximum in case of tissues from fetuses of early period of development, suggesting greater susceptibility of human fetus towards this organophosphorus insecticide.

Effects of organophosphorus insecticide phosphomidon on antioxidant defence components of human erythrocyte and plasma.

Effect of organophosphorus insecticide, phosphomidon (250 and 500 ppm) on human erythrocyte and plasma were studied in vitro to get insight into the cellular antioxidant defence mechanism and malondialdehyde formation. The antioxidant defence system of erythrocyte was altered as evident by depression of glutathione reductase, glucose 6 phosphate dehydrogenase, whereas the level of reduced glutathione, glutathione peroxidase, glutathione-S-transferase, superoxidedismutase and catalase were stimulated. In the case of plasma fraction, glutathione reductase, glutathione peroxidase, glutathione-s-transferase, glucose-6-phosphate dehydrogenase, superoxide dismutase and levels of reduced glutathione were significantly depressed and the malondialdehyde formation and catalase activity were elevated indicating the less adaptive response of plasma to protect it from oxidative damage.

Age-related changes of glycogen metabolism in human fetal heart.

The changes in the activities of three important glycogen metabolising enzymes, viz. glycogen synthetase, glycogen phosphorylase and alpha-D-glucosidase, along with glycogen content have been measured in adult human heart and human fetal heart collected at 13-36 weeks of gestation. At an early period, particularly 13-16 weeks of gestational age, the activity of glycogen synthetase and glycogen content were found to be maximum. However the activity of glycogen phosphorylase remained constant throughout the gestation and that of alpha-D-glucosidase showed a peak at 25-28 weeks of gestation, thereby indicating that fetal heart tissue has the capacity to utilise glycogen for energy.

Glycogen metabolism in human fetal testes.

The ontogeny of glycogen synthetase, glycogen Phosphorylase and α-Dglucosidase, enzymes which are associated with glycogen metabolism and glycogen level has been studied in human fetal testes of gestational age ranging from 14-32 weeks. Glycogen synthetase activity reaches the peak value at 17-20 weeks of gestation, thereafter it decreases. α-D-Glucosidase activity increases with the advancement of pregnancy up to 28 weeks of gestation decreasing thereafter very rapidly. Phosphorylase activity remains more or less constant throughout gestation. The maximum increase in glycogen content at early stages of gestation (17-20 weeks) and gradual reduction with the advancement of pregnancy are correlated with histochemical observation by the periodic acid-Schiff technique.