Mixed Medullary and Papillary Carcinoma Thyroid in a Young Female- A Rare Case Report

The medullary thyroid carcinomas (MTC) comprise 5-10% of all thyroid carcinomas. It is known to show many cyto-architectural variations. The WHO classification of thyroid tumors includes an entity called mixed medullary-papillary carcinoma, a rare malignancy known to represent <1% of all thyroid malignancies. Fewer than 40 such cases have been reported so far and include tumors showing morphological features of both medullary carcinoma and papillary carcinoma with immunoreactivity for calcitonin and CK19 &thyroglobulin respectively. We report a case of a 27-year-old female with complaints of gradually increasing neck swelling for 2 years, with difficulty in swallowing in the last 2 months. The swelling was more localized towards left. Ultrasound neck revealed a nodule in the left lobe of thyroid with benign features most likely nodular colloid goiter. Thyroid profile of the patient was normal. FNA revealed sheets and follicles lined by both hyperplastic and involutional follicular cells. Few micro follicles showed pleomorphic cells having hyperchromatic nuclei and mild anisonucleosis. A diagnosis of colloid goiter was given on cytology; however, on grounds of suspicion of a neoplastic process, histopathology was advised. The patient underwent total thyroidectomy. Hematoxylin & Eosin stained sections showed features of mixed medullary-papillary carcinoma of the thyroid which was further confirmed on Immunohistochemistry and raised serum calcitonin levels. It is important to know about this entity due to its prognostic implications, association with other endocrine disorders and to prevent any diagnostic dilemmas.

Gingival Granular Cell Lesion-Congenital Epulis.

Gingival granular cell tumour or congenital epulis is a rare benign soft tissue tumour that occurs mostly over lateral alveolar ridge of maxilla. The lesion behaves in a benign manner with spontaneous regression and without any recurrence or metastasis. We hereby report a case of congenital epulis in a 5 weeks old, baby girl who presented with single sessile mass over right side of maxillary alveolar ridge since birth; and want to emphasize that although rare this entity should always be considered in differential diagnosis of neonatal lesions of the oral cavity.

Dysgerminoma with pregnancy and viable baby: a case report

Dysgerminomas are the most common of primitive germ cell tumors of the ovary, accounting for 1-5% of all ovarian malignancies. The reproductive age group females are most commonly affected, thereby causing problems in conception and if pregnancy occurs, it leads to feto-maternal compromise. It is extremely rare to have a successful natural pregnancy, with viable child birth with a coexisting dysgerminoma, without any assisted reproductive interventions. We hereby report a case of successful spontaneous natural pregnancy in a primi gravida, associated with dysgerminoma, with no feto-maternal compromise

Primary neuroendocrine carcinoma of the breast.

Primary neuroendocrine carcinoma of the breast is rare-only about 30 cases have been reported in literature. Immunohistochemical examination showing expression of chromogranin and/or synaptophysin confirms evidence of neuroendocrine differentiation. Usually foci of neuroendocrine differentiation can be seen in breast carcinoma and are reported to be present in about 2-5% of breast cancer cases. Here, we report a case of breast carcinoma in which most of the areas studied on the tissue section showed neuroendocrine differentiation.

Microfilariae in Testicular Fine Needle Aspiration Biopsy.

Filariasis due to Wucheria bancrofti is endemic to Southern Asia. While the laboratory diagnosis has been conventionally made by demonstrating microfilariae in peripheral blood smears, these have also been occasionally diagnosed on aspiration cytology of various organs. This paper reports the finding of microfilariae in material obtained from the testicular mass in an eighteen year old male by fine needle aspiration (FNA) cytology.

Actinomycosis - Left Post Chest Wall.

A forty year old female of weak body built presented with recurring small hard lumps in let posterior chest wall for 3 years and discharging ulcers for 3 months duration. Clinically, the provisional diagnosis was malignancy with secondary infection. FNAC showed features suggestive of dysplasia but histopathology confirmed the diagnosis as actinomycosis. The present case is reported due to rare incidence of actinomycosis at post chest wall with muscle involvement.

Combined modality cytopathologic diagnosis of lung malignancy: a feasible proposition?

Primary carcinoma of lung is a major health problem with a generally grim prognosis. Cytology is reliable and useful method in the diagnosis of bronchogenic carcinoma. However, an orderly approach to diagnosis, using a variety of cytologic diagnostic procedures helps us to separate benign and malignant lesions of lung and allows early diagnosis and cytologic typing of various pulmonary malignant lesions. That provides perspective selection of best therapy for individual patient. We have reached to a conclusion from the present study that multiple types of tissue sampling techniques including bronchial brushing, transbronchial needle aspiration [TBNA], CT-guided transcutaneous needle aspiration [TCNA] and bronchial biopsy should be performed since the diagnostic results improve when combination of techniques are employed

Ultrasound Guided Fine Needle Aspiration Biopsy of Abdominal Masses

Ultrasound guided fine needle aspiration biopsy of abdominal masses. Material Methods: 200 patients with abdominal lump were subjected to fine needle aspiration biopsy by a 20-22 G needle and smears prepared were stained with H & E and Papanicolaou stains. Histopathological specimens were processed and stained with H & E stain and a cytohistological correlative study performed. 128 (74%) were females and 72 (36%) were males. 83 cases (41.5%) had a mass in the hepatobiliary region, out of which 53 (63.9%) had a mass in the gall bladder. Malignant lesion constituted the commonest cytologic diagnostic category 115 cases (57.5%). Adenocarcinoma gall bladder was found in 31 cases (37.3%) followed by metastatic adenocarcinoma liver in 12 cases (14.5%) and hepatocellular carcinoma in 8 cases (9.6%). Adenocarcinoma stomach 8 cases (18.6%) was the commonest GI malignancy followed by adenocarcinoma intestine 7 cases (16.3%). Serous cystadenocarcinoma comprised the commonest ovarian cancer, 5 cases (12.5%) followed by mucinous cystadenocarcinoma, 2 cases (5.1%). Overall sensitivity of 94.11%, specificity of 100% and diagnostic accuracy of 95.7% was found in the present cytohistological correlative study.

Mammography-guided stereotactic fine needle aspiration cytology of breast lesions.

The purpose of the present study was to evaluate the efficacy of mammographic guided stereotactic fine needle aspiration cytology in 136 patients with breast lesions including mammographic features, cytomorphological findings and nuclear grading in malignant cases. Majority of the cases were predictable correctly by combination of the three modalities of diagnosis viz, clinical examination, mammography and cytology.

Study of Fine Needle Aspiration Cytology in Lymphadenopathy with Special Reference to Acid-fast Staining in Cases of Tuberculosis

The present study was conducted to evaluate the usefulness of FNAC as a diagnostic tool in 1000 patients of lymphadenopathy. Fine needle aspiration was performed in all the patients following through clinical examination and slides were stained with H & E, PAP and Ziehl Neelsen stains. The results of FNAC were further correlated with paraffin embedded sections of tissue blocks. Eight hundred and sixty-four cases (86.4%) were of benign lymphadenopathy; out of which 536 (53.6%) cases were of reactive nature and 328 cases (32.8%) were tubercular. The remaining 136 (13.6%) cases were of malignant lymphadenopathy, consisting 45 (4.5%) cases of primary malignancies i.e. lymphomas and 91 (9.1%) cases of metastasis to lymph nodes. Out of 328 cases, Z-N positivity for AFB was found in 152 cases (46.4%) and Mantoux test was positive in 180 cases (54.9%). On correlation of FNAC findings with histopathology; sensitivity and specificity was found out to be 91.6% and 99%, respectively, with diagnostic accuracy of 97.3% in cases of benign lesions. The same being 97%, 97.5% and 97.4%, respectively in tubercular lesions. The sensitivity, specificity and diagnostic accuracy was 100% each in malignant lesions. FNAC of lymphnodes is an excellent first line method, for investigating the nature of the lesions, as it is economical and convenient alternative to open biopsy.

Effect of intervention on promotion of exclusive breast feeding

community-based intervention study was conducted in a Katchi Abadi [slum area] of Karachi with the objective of improving optimal breast feeding practices, including promotion of exclusive breast feeding and giving of colostrum to newborns. Sixty-seven mothers were registered in the intervention group and 53 in the control group. Health education to promote exclusive breast feeding was provided in the form of flip-charts, videos and photographs. Sixty-six% mothers in the control group gave prelacteals as compared to 31% in the intervention group [P <.0001]. Colostrum was given by 97% mothers in the intervention group and 3% in the control group. Majority [94%] of intervention group mothers continued exclusive breast feeding till four months of age against 7% in the control group. It was concluded that health education programmes in the antenatal period as well as after birth can promote exclusive breast feeding practices