Epithelioid trophoblastic tumor: A case series

An epithelioid trophoblastic tumor (ETT) is an extremely rare gestational trophoblastic tumor. Cases of ETT present with abnormal vaginal bleeding in women of reproductive age group with marginally elevated beta human chorionic gonadotrophin (B-hCG) levels. Here, we describe a series of four patients (all were females) including histomorphology, immunoprofiles, and diagnostic difficulty of this rare entity. All cases were in their reproductive age group. The mean pre-treatment hCG level was 665.24 (mIU/mL). Microscopically, all cases had a tumor showing an epithelioid appearance arranged in large nests and sheets. Individual tumor cells were round to polygonal with abundant eosinophilic cytoplasm, with central vesicular nuclei and prominent nucleoli. Areas of hemorrhage, necrosis, and intercellular hyaline-like material deposition were identified in all cases (100%). Immunohistochemically, tumor cells in all cases showed diffuse positivity for AE1/AE3 and p63 (100%). GATA3 was available in one case (25%), which was positive in the tumor cells. In one case (25%), hPL was focally positive, and in one case (25%), it was negative. SALL4 was performed in two cases (50%) and was negative in tumor cells. The mean Ki67 labeling index was 19.2 (range 10–30%). All four patients underwent surgical intervention and were treated with hysterectomy. The mean follow-up in this series was 39.4 months (range 6–70), and all patients are alive to date with a mean survival of 32.8 months (range, 4–67).

A study of acute febrile encephalopathy with special reference to viral etiology.

OBJECTIVE: To study the etiological profile of patients with acute febrile encephalopathy syndrome focusing chiefly on the viral etiology, and to correlate clinical and radiological features of patients with viral encephalitis. METHODS: A prospective hospital based study conducted on the consecutive patients admitted in a pediatric unit during the period of 1(st) February 2004 to 31st January 2005 based on the following inclusion criteria: (1) Age more than 1 month and less than 18 years and (2) A diagnoses of acute febrile encephalopathy, based on the following criteria: (i) fever (ii) acute depression of consciousness or mental deterioration for more than 12 hours with or without motor or sensory deficit and (iii) Total duration of illness at the time of admission 1 week or less. RESULTS: The final study group comprised of 151 patients with mean age of 3.21 +/- 2.9 (range of mth-13 years) and male: female ratio of 1.71: 1. A diagnosis other than viral encephalitis was reached in 94 patients (62.3 %). Pyogenic meningitis was the most frequent diagnosis 51(33.8 %) followed by tubercular meningitis 12 (7.9 %), and cerebral malaria 8 (5.2 %) in the patient group of non-viral causes. Fifty-seven cases (37.3%) were suspected as viral encephalitis and mean age of the cases suspected as viral encephalitis was 2.8 +/- 2.9 (Range 1 mth-10 yrs) with male: female ratio of 1.28: 1. Etiological diagnosis was reached or considered probable in 41 (72%) cases out of the suspected patients. The most common etiological agent identified was enterovirus 71 in 20 patients (35.1 %). The other viruses identified were mumps in 6 (10.5%), Japanese encephalitis in 5 (8.7%), and measles in 4 (7%) cases. MRI brain was done in 39 patients and was abnormal in 14 patients. Out of 57 cases of suspected viral encephalitis 10 patients expired within 48 hours, 2 > 48 hours and 19 atients had significant neurological sequels at discharge. CONCLUSION: The etiology of acute febrile encephalopathy varies from infectious etiologies to noninfectious metabolic disorders. There are no distinguishing clinical or radiological features to differentiate the various causes of viral encephalitis. The clinical and the radiological findings in encephalitis should be interpreted in the geographical and other epidemiological background.

Genetic transformation and hairy root induction in Holostemma ada-kodien K. Schum--a vulnerable medicinal plant.

Hairy roots were induced from shoot buds and seedling hypocotyls of Holostemma by infection with agropine type Agrobacterium rhizogenes strains. Type of explant, Agrobacterium rhizogenes strain used for infection, co-culture time and photoperiod influenced the transformation frequencies. Hairy roots were induced from seedling hypocotyls and shoot bud explants upon infection with agropine type Agrobacterium rhizogenes strains. The hairy roots were thin, whitish in colour and showed negatively geotropic growth. The transformed nature of hairy roots was confirmed by opine analysis.

Spina bifida clinic--organisational aspects.

Spina bifida is a complicated problem which affects many systems and demands multidisciplinary attention. The psychosocial aspects of a condition like spina bifida also need to be carefully handled. The ultimate goal is prevention, requiring co-ordinated efforts to establish antenatal diagnosis and screening tests for this anomaly. In our country, the task of solving the difficulties faced by these children at home and in school also falls on our shoulders. All the above responsibilities can only be undertaken if a group of doctors, nurses, social workers, administrators and philanthropists are dedicated to the care and well being of these children. A special clinic helps to create and maintain such a group in order to provide for all, the varied medicosocial needs of a spina bifida patient under one roof.

Gastric volvulus in childhood.

Gastric volvulus is an uncommon condition more so in the paediatric age group. The cause of gastric volvulus may be idiopathic or secondary to various congenital or acquired conditions. In this short series of three patients, one had volvulus which was due to ligamentous laxity and mobile spleen, second had congenital postero-lateral diaphragmatic defect and the third had hiatus hernia.

Proximal jejunal obstruction due to eosinophilic gastroenteritis.

Eosinophilic enteritis or gastroenteritis is a rare disease characterised by tissue eosinophilia which can affect different layers of bowel wall. It can affect any area of gastrointestinal tract from the esophagus to the rectum, although stomach and small intestine are sites most frequently reported. It is important to recognize this disease early and institute the necessary treatment. An eight year old girl presented with acute intestinal obstruction. Exploration revealed a structure of proximal jejunum. Histopathology demonstrated eosinophilic jejunitis. The case is reported owing to this rarity and relevant literature is reviewed.

Cystic mesenchymal hamartoma of the liver--a rare condition.

Cystic Mesenchymal Hamartoma of the liver is a rare benign tumour of infancy. Congenital cysts of the liver are of two main types: mesenchymal hamartoma and non parasitic cysts. The latter are encountered frequently while liver hamartomas are rare. The first reported case of mesenchymal hamartoma was that of Maresch in 1903. In 1956 Edmondson reviewed the literature and proposed the term "Mesenchymal Hamartoma" as a new clinical entity. In this paper we are discussing a rare case of cystic mesenchymal hamartoma of the liver, its clinical presentation, pathological characteristics, options of management and reviewing the relevant literature.

Prepyloric diaphragm detected following foreign body ingestion.

Prepyloric diaphragms are unusual and are usually detected in adulthood. We report a five-year-old boy who presented with history of ingestion of a coin and was found to have a prepyloric diaphragms on laparotomy.

Blastopathies--symmetrical conjoined twins.

Conjoined twins are one of the rarest blastopathies, challenging the medical profession. The incidence in India is reported to be 1:60,000 pregnancies. This report records two cases of female conjoined twins. The sharing of various organs and complex cardiac anomalies encountered were very fascinating. Omphalopagus conjoined twins had only three lower extremeties, a common gastro-intestinal tract beyond the terminal ileum, crossed ectopia, hypoplastic kidneys and bicornuate uterus. The heart showed dextrocardia, A.S.D. and V.S.D. No attempt was made for surgical separation in this case. The second case was a thoracopagus, with the heart showing V.S.D., cor triatrium dexter with a posterior venous chamber. Surgical separation was attempted, but was unsuccessful. Both cases showed a single fused liver. The need for antenatal diagnosis and successful separation with good pre- and post-operative management is stressed.

Rectal duplication.

Duplications of the alimentary tract are of a great rarity, particularly so in the rectum. Because of its rarity, the difficulty of making a correct diagnosis and of selection of proper approach for treatment, this entity bears a special significance. The present case report deals with a female newborn who presented with imperforate anus and a rectovestibular fistula and a mass prolapsing at the introitus. Complete excision of the mass was carried out through the perineal approach and the child then underwent, a PSARP for the correction of the rectal anomaly. Histology confirmed the mass to be a rectal duplication.

Gastrostomy without laparotomy--a percutaneous endoscopic technique: review of 35 cases.

Percutaneous endoscopic gastrostomy (PEG) was performed in 33 patient with head injury, one with laryngeal cancer, and one with gastric volvulus. The gastrostomy tube was prepared from 20 F Foley catheter and a plastic micropipette tip. The complications encountered included peritubal leak in three patients (9%) and abdominal wall hematoma in one patient (3%). There was no procedure-related mortality. We recommend PEG for tube enteral feeding in patients who have lost the swallowing reflex.