A practical diagnostic approach to hepatic masses

The differential diagnosis of hepatic mass lesions is broad and arriving at the right diagnosis can be challenging, especially on needle biopsies. The differential diagnosis of liver tumors in children is different from adults and is beyond the scope of this review. In adults, the approach varies depending on the age, gender, and presence of background liver disease. The lesions can be divided broadly into primary and metastatic (secondary), and the primary lesions can be further divided into those of hepatocellular origin and nonhepatocellular origin. The first category consists of benign and malignant lesions arising from hepatocytes, while the second category includes biliary, mesenchymal, hematopoietic, and vascular tumors. Discussion of nonepithelial neoplasms is beyond the scope of this review. The hepatocytic lesions comprise dysplastic nodules, focal nodular hyperplasia, hepatic adenoma, and hepatocellular carcinoma, and the differential diagnosis can be challenging requiring clinicopathological correlation and application of immunohistochemical (IHC) markers. Liver is a common site for metastasis, sometimes presenting with an unknown primary site, and proper workup is the key to arriving at the correct diagnosis. The correct diagnosis in this setting requires a systematic approach with attention to histologic features, imaging findings, clinical presentation, and judicious use of IHC markers. The list of antibodies that can be used for this purpose keeps on growing continually. It is important for pathologists to be up to date with the sensitivity and specificity of these markers and their diagnostic role and clinical implications. The purpose of this review is to outline the differential diagnosis of hepatic masses in adults and discuss an algorithmic approach to make a right diagnosis.

Validated stability-indicating HPLC method for simultaneous estimation of ofloxacin and satranidazole from pharmaceutical dosage form.

The present paper describes development of stability- indicating RP- HPLC method for the simultaneous determination of Ofloxacin and Satranidazole in presence of its degradation products, generated from forced degradation studies. Ofloxacin and Satranidazole and their combination drug product were exposed to acid, base, neutral hydrolysis; oxidation, dry heat, photolytic stress conditions and the stressed samples were analyzed by proposed method. The proposed HPLC method utilizes HiQ sil C18W column (250mm × 4.6mm i.d., 5μm) of KYA TECH, Corporation and a mobile phase comprising of acetonitrile: phosphate buffer (pH3) in ratio of 35:65v/v with flow rate of 1ml/min. The retention time of OFLX and STZ was found to be 2.85min and 6.25min respectively. Quantitation was achieved with UV detection at 296nm for OFLX and 320nm for STZ. The method has been validated for ofloxacin and satranidazole in terms of accuracy, precision, linearity, LOD, LOQ and robustness. The developed validated stability-indicating HPLC method was found to be simple, specific, accurate and reproducible for the determination of instability of these drugs in bulk and commercial products.

Cerebral chromoblastomicosis--a rare case report of cerebral abscess and brief review of literature--a case report.

A rare case of Cerebral Chromomycosis caused by chromogenic fungus Cladosporium trichoides in a 35 year old male with classical presentation of cerebral abscess is being presented. The case report lays emphasis on the histological diagnosis of chromogenic fungus in the wall of the abscess cavity, surgically removed from a well delineated circumscribed lesion in the frontal lobe of the cerebrum. The causative fungus could be detected even in unstained paraffin sections. The diagnosis could be made only after surgical removal and histopathological examination. The mycological culture could not be made as the material was received in formaldehyde fixative. The unique features of the case is its recurrence free uneventful survival five years after surgical excision. This is probably the fifth reported case of cerebral chromomycosis from India and first of its type from arid zone of Rajasthan.

Hepatic sarcoidosis responding to chloroquine as steroid-sparing drug.

We report a 59-year-old lady who presented with exertional dyspnea and was diagnosed to have sarcoidosis. She responded to steroids, but one year later developed abdominal symptoms and was found to have hepatosplenomegaly. Liver biopsy showed non caseating granulomas. As she had developed steroid-induced diabetes she was started on chloroquine and responded well with regression of the liver and spleen during one year of treatment.

Granular cell ameloblastoma of jaw. A report of rare case and brief review of literature.

Ameloblastoma is an epithelial odontogenic tumour of the jaw and exhibits diverse microscopic patterns which occurs either singly or in combination with other patterns. The rare granular cell variant is seen in combination usually with follicular or plexiform subtypes. The reported case reveals the microscopic patterns characteristic of granular cell variant only, which is uncommon. The tumour was excised and no recurrence has been observed after nineteen months of surgery.

CSF/blood glucose ratio and other prognostic indices in pyogenic meningitis.

Fifty cases of pyogenic meningitis were examined for various prognostic indices, especially cerebrospinal fluid (CSF)/blood glucose ratio. Overall mortality was 40%. Age below one year and depressed level of consciousness were associated with high mortality. Illness of more than 7 days, presence of associated illness and absence of neck rigidity were not found to be statistically significant factors associated with higher mortality. CSF leucocyte count of more than 1000 cells/cmm and CSF protein more than 500 mg/dl were statistically significant factors associated with higher mortality. In cases of CSF glucose level below 20 mg/dl and CSF/blood glucose ratio below 0.2, the increase in mortality was highly significant. CSF/blood glucose ratio in cases who recovered was much higher than those who died. CSF/blood glucose ratio increased to normal in cases who recovered but remained low in cases who expired.

Immunoglobulin profile in mycetoma.

Serum samples obtained from 25 patients of mycetoma caused by Madurella mycetomi in 18, Streptomyces somaliensis in 5, Streptomyces madurae and streptomyces palletierii from 1 each and also from 25 healthy controls were evaluated for immunoglobulins IgG, IgM and IgA by radial immunodiffusion method using tripartigen plates. All the three classes of immunoglobulins showed increased concentration in cases of mycetoma by M. mycetomi and S. pelletierii. The raised levels of IgG and IgM in cases of mycetoma caused by S. madurae and S. somaliensis where bones were involved, were not statistically significant. IgA was consistently high in all cases of mycetoma irrespective of causative agent and tissue involved. These alterations may possibly reflect relatively poor IgG and IgM response in individuals with extension of mycetoma lesion to bones.

Omento-mesentral myxoid hamartoma--a case report.

Omento-mesentral myxoid hamartoma, a very rare lesion seen in children, is reported in a three year old child. Its rarity, problem in its clinical pre-operative diagnosis, its characteristic gross and microscopic features, its benign, non recurrent clinical course is stressed.

A 18 years study of testicular tumours in Jodhpur, western Rajasthan.

The present study based on WHO histologic typing of testicular tumours deals with 100 cases recorded in the files of the Department of Pathology from 1969 to 1987. These tumours accounted for 2.57% malignancies of male genital system. Maximum number of tumours were recorded in the third and fourth decades. Right testis was affected in 60% cases. Scrotal swelling was the predominant presenting feature, followed by pain. Five cases of testicular tumours were observed in undescended testis. Germ cell tumour of one histologic type constituted 76% of testicular tumors. Germ cell tumors of more than one histologic type were 23%. One case (1%) belonged to lymphoid and haemopoietic system and was of large cell lymphocytic lymphoma. Amongst the germ cell tumors with one histologic type, seminoma (34%) and embryonal carcinoma (28%) were predominant while teratocarcinoma was a predominant tumour in combination group.

Renal angiomyolipoma (report of 2 cases).

Renal angiomyolipoma, a rare benign renal neoplasm constitutes less than 3 percent of all renal neoplasm. Two rare cases of renal angiomyolipoma were reported from the Department of Pathology, Dr. S.N. Medical College, Jodhpur in last fifteen years. Both were not associated with tuberous sclerosis. The relevant literature on the subject is reviewed.