Solid and cystic epithelial neoplasm of pancreas with metastasis: a report of a highly unusual case

Solid and cystic papillary epithelial neoplasms of the pancreas are uncommon tumors occurring predominantly in young women. These tumors have excellent prognosis and after complete surgical resection, more that 95% patients are cured. Occasionally, they invade the surrounding pancreatic parenchyma. These tumors can recur even many years after resection, so long term follow up is essential. Very few cases metastasize. We present a case of a middle aged woman with metastases to liver and omentum

Systemic lupus eryhematosus presenting as Hemolytic uremic syndrome: a case Report

Associating systemic lupus erythematosus [SLE], with an initial presentation of hemolytic uremic syndrome [HUS] is rare. We report a case of 21-year old Afghani female admitted to our hospital with an initial complaint of high grade fever and diffuse maculopapular rash and swelling of lower limbs. Diagnosis of atypical HUS was established according to the clinical triad of HUS without a veriotoxin-producing organism in her stool and the pathological finding compatible to thrombotic microangiopathy. In addition, her symptoms fulfilled the 1982 revised criteria for the classification of SLE. After pulse methylprednisolone, cyclophosphamide and plasmapheresis therapies, her laboratory findings and general condition improved. Unfortunately she was lost to follow up as she decided to return back to Afghanistan

case of non - resolving cough and Weight loss

Sarcoidosis is a chronic granulomatous multi-system disease with a clinical picture often mimicking tuberculosis. We present a case of a patient who presented with a clinical picture akin to both of these granulomatous disorders and was started on anti-tuberculous regimen despite the lack of any solid evidence pointing towards tuberculosis. As a result her clinical condition continued to deteriorate for months until finally a bronchoscopic biopsy established her disease process as sarcoidosis. She was then started on systemic corticosteroid therapy for sarcoidosis and during the ensuing period has shown marked improvement in her clinical picture with near normalization of the biochemical and radiographic parameters of her pathology. This case illustrates the need for vigilant interpretation of the clinical scenario in patients such as these where a misdiagnosis may lead to significant patient distress as well as weighing down on the economic and health resources

Renal cortical necrosis: a case series of nine patientns and review of literature

The purpose of this study is to review cases of renal cortical necrosis [RCN] which we came across during a period of five years, confirmed on needle biopsy specimens, with literature available so far. All renal biopsy records between January 1996 to December 2001 at the Aga Khan University Hospital, Karachi, Pakistan were reviewed to identify patients with histologically proven renal cortical necrosis. Seven patients were also referred by the department of Nephrology, Lady Reading Hospital, Peshawar, Pakistan. Patients' medical records were reviewed for demographic, clinical, and follow up data. There were total of nine patients identified with renal cortical necrosis. The mean age was 26.21 +/- 13.01 year. Five cases [55.5%] were caused by obstetric complications. The most common histology type of RCN was patchy cortical necrosis in seven patients [77.8%]. Three patients were alive at last follow up; remaining patients were lost to follow up. Obstetric complications remain the leading cause of renal cortical necrosis in our setting. The recognition of this entity and value of renal biopsy in cases of acute renal failure needs to be emphasized as this helps in establishing diagnosis, to assess prognosis and to aid in selection of a rational approach to therapy

Central nervous system lymphomas: a histologic and immunophenotypic analysis

OBJECTIVE: To observe the spectrum of non-Hodgkin's lymphomas involving the central nervous system including morphological subtypes and immunophenotypic status. SETTING: Retrospective analysis of eleven years [1986 to 1996] data from surgical pathology files of Department of Pathology. Forty-three cases of non-Hodgkin's lymphomas were diagnosed during the period of eleven years [from 1986 to 1996], all of which were diffuse types. A total of 1177 Central Nervous CNS biopsies were examined, out of which 937 cases were diagnosed as CNS neoplasms, the remaining were non-neoplastic in nature. Among 937 CNS neoplasms, 43 cases [4.6%] were reported as non-Hodgkin's lymphomas. As most of the cases were outside referrals, the primary or secondary nature of the lymphomatous process could not be assessed. Seventeen cases were intracranial, while 26 cases were spinal in location. Majority of the intracranial lymphomas were biopsied from the cerebrum [12 cases]. Male to female ratio was 1:2. The median age for intracranial lymphomas was 50 years and for spinal lymphomas 29 years. There were 16 cases [37%] of diffuse large cell lymphomas; 7 cases [16%] of diffuse mixed small and large cell lymphomas; 3 cases [7%] of diffuse large cell immunoblastic lymphomas; 2 cases [4.6%] of lymphoblastic lymphomas and diffuse small non-cleaved cell lymphomas and one case of small lymphocytic lymphoma and diffuse small cleaved cell lymphoma. One case of T cell rich B cell lymphoma was also diagnosed in the thoracic spine as primary extranodal lymphoma. Eight cases were unclassifiable and in 2 cases the features were suggestive of lymphoma. Immunophenotypic analysis was performed in 20 cases, however, in 2 cases the results were inconclusive. Fifteen cases [83%] showed immunoreactivity for B cell markers and 3 cases showed T cell phenotype out of which one case was lymphoblastic lymphoma. CNS lymphomas were uncommon tumors and comprised 4.6% of the total CNS neoplasms in our study. Moreover, these CNS lymphomas accounted for 2.2% of the total non-Hodgkin's lymphomas, including both nodal and extranodal. There was a higher incidence of location of these lymphomas within the spinal cord than brain. Most of the lymphomas were of intermediate or high grade [75%] according to the working formulation. Immunophenotypical status revealed B-cell phenotype in 84% of the lymphomas, in which it was tested [JPMA 50:141, 2000]

Chromomycosis: a pigmented fungal infection mimicking squamous cell carcinoma of skin

A 20 year old male, resident of rural area of Sindh province presented with fungating growth over bridge of the nose. The patient has a similar lesion on medial side of left knee since one year. The patient also had an identical lesion on lateral side of right thigh excised sometime back and histopathology of the lesion revealed foreign body granulomatous reaction. On examination the growth over bridge of the nose was fungating cauliflower like and measured 5x5 cms. The lesion on me dial side of left knee was similar in appearance and measured 3x3 cms. Both the lesions were non-tender, ulcerated, covered by purulent exudate and margins were well defined. Pus was sent for culture and sensitivity which grew staph. Aureus. Multiple biopsies from both nasal and left knee growths were taken and sent for histopathologic examination