Haemobilia due to a large gall bladder polyp.

A 61-year-old male presented with recurrent bouts of haematemesis and melaena for last 10 days. On examination, he was found anaemic and had jaundice and a mass felt in the right hypochondrium. He required multiple blood transfusions. Oesophagogastroduodenoscopic (OGD) evaluation demonstrated no lesion, no fresh bleeding noticed from ampulla of Vater. Ultrasonographic evaluation demonstrated a heterogeneous mass within the gall bladder lumen with a chink of free lumen between the mass and gall bladder wall and also dilated biliary tract. Laparotomy confirmed mass within the gall bladder lumen without any lymph node involvement at porta or any liver metastasis, and had dilated common bile duct. Cholecystectomy was carried out. The cut section of the gall bladder showed a polypoid mass (5.5 cm x 4 cm) projecting inside lumen having a haemorrhagic spot on irregular surface and which was attached with fundus of the gall bladder through a small stalk. Choledochotomy showed only blood clots within the duct-choledochoduodenostomy was also done. Histopathological examination showed adenomatous polyp with foci of carcinoma in-situ or ly without any evidence of local metastasis. Follow-up was uneventful till after 11 months.

Argyrophilic nucleolar organiser regions (AgNORs) in breast lesions.

Nucleolar organiser regions (NORs) demonstrated by argyrophilia of NOR-proteins are indicator of cellular proliferative activity. The NORs can be identified in the nuclei as brown or black dots with silver colloidal staining technique in formalin fixed paraffin sections and in cytology smears. Seventy-five cases including 45 tissue sections and 30 fine needle aspiration cytology (FNAC) smears of benign and malignant lesions of breast have been studied to evaluate the significance and practical application of AgNOR count per nucleus. Out of 45 tissue sections 15 belonged to fibrocystic disease, 10 fibro-adenomas and 20 carcinomas and of the 30 FNAC smears, 10 were fibrocystic disease, 8 fibro-adenomas and 12 carcinomas. In fibrocystic disease the mean AgNOR count was 1.60 (FNAC group-0.75, tissue section-1.61). In fibro-adenomas it was 1.61 (FNAC-1.63, tissue section-1.59). The mean count in carcinoma was 12.10 (FNAC-12.08, tissue section-12.10). The difference in AgNOR count in fibrocystic disease and fibro-adenoma was not significant, but that between benign breast lesion and carcinoma was significant. No difference was observed between FNAC and tissue section groups in benign or malignant lesions. The simple staining technique can be used as an additional criterion to differentiate the benign and malignant lesions of breast.