Profile of pancreatic tumors at a tertiary care center.

BACKGROUND: Pancreas, a relatively inaccessible organ, poses diagnostic difficulties with overlapping presentation among benign and malignant tumors. In the present study, pancreatic aspirates obtained by computed tomography (CT) guided procedures were used for cytodiagnosis. Our study aims at correlating clinical, cytological, biochemical, and histopathological results in obtaining a final diagnosis. METHODOLOGY: A retrospective study of 2 years was done which included 32 cases of pancreatic tumors at a tertiary care center. Patient data were retrieved and analyzed. RESULTS: Twenty-seven of the 32 (84.37%) cases were malignant tumors. Age distribution in malignant tumors was predominantly seen in the fourth to eighth decade, whereas in benign, it ranged in the second to third decade. Thirteen out of the 32 (40.62%) cases reported were females, with male:female ratio of 1.46:1. The most common presenting symptom was abdominal pain followed by jaundice and vomiting. Three of the 32 cases had visceral metastasis at the time of diagnosis. CT-guided aspirates in most cases yielded diagnostic material. Cytological and histopathological results concurred except for three cases. Cancer Antigen 19-9 was worked up for 14 of 27 malignant cases, 11 of which showed grossly elevated values (700-7000), and three cases showed mildly elevated values (100-300). Three of the four benign cases worked up for CA 19-9 showed normal values. CONCLUSIONS: Among the mass forming lesions in pancreas, malignancy was more common compared to benign tumors. A multidisciplinary approach in the assessment and diagnosis of pancreatic tumors yields accurate results in spite of the limitations faced in obtaining adequate samples by needle aspirates.

Multiple retroperitoneal paragangliomas.

Paragangliomas are rare with multicentricity being more common in patients with familial history. Early recognition of the characteristic symptoms of headache, palpitations, and diaphoresis in a patient with hypertension and prompt appropriate intervention can minimize the morbidity associated with such tumors and prevent a potentially fatal outcome. Paragangliomas represent neoplasms of neural crest origin that arise from paraganglia. Paragangliomas are tumours arising in extra-adrenal paraganglia either in the paravertebral space. We report a rare case of two discrete paragangliomas in the retroperitoneum of a young girl presenting with throbbing headache. Contrast Enhanced CT Abdomen showed the lesions as a large irregular heterogeneous and intensely enhancing mass lesions. Elevated levels of vanillylmandelic acid were found in the Urine. The lesions were removed by surgery and the histopathologic findings of both the lesions confirmed the diagnosis of multiple paragangliomas. Early identification and early surgery will minimize the potential risks and complications in this condition.

Intraoperative consultation and smear cytology in the diagnosis of brain tumours.

BACKGROUND: Intraoperative smear cytology provides a rapid and reliable intraoperative diagnosis and guidance to the neurosurgeon during surgical resection and lesion targeting. It also helps the surgeon to monitor and modify the approach at surgery. OBJECTIVES: 1) To assess the utility of intraoperative smear cytology and correlate with the final histopathological diagnosis. 2) To describe the cytomorphological features of common brain tumours in smear preparation. MATERIALS AND METHODS: The material for this study was obtained from 100 consecutive biopsies of central nervous system neoplasms sent for intraoperative consultation. Smears were prepared from the biopsy samples sent in isotonic saline for immediate processing. The smears were stained by the rapid Haematoxylin and Eosin method. The cytomorphological features were noted and correlated with paraffin section findings. RESULTS: Of the total 100 cases, 86 showed accuracy when compared with histopathological diagnosis. This was comparable with other studies. Of the remaining, two cases were frank errors, 12 cases showed partial correlation, with five cases showed incomplete typing of the cell type and seven, discrepancy in grading of tumours. The error percentage was 14%. Correlation with clinical details and radiological findings were helpful in improving the accuracy rate. CONCLUSIONS: Smear technique is a fairly accurate, relatively safe, rapid, simple, easily reproducible and cost effective tool to diagnose brain tumours. Smear cytology is of great value in intraoperative consultation of central nervous system pathology.

Mechanism delineating differential effect of an antiestrogen, tamoxifen, on the serum LH and FSH in adult male rats.

Tamoxifen, a synthetic non-steroidal antiestrogen with residual estrogenic activity, administered to adult male rats reduces their fertility. A decrease in the circulating LH and testosterone levels with a transient rise or no change in circulating FSH levels was observed. The present study was carried out to delineate the mechanism causing the differential effect of tamoxifen on circulating gonadotropins by correlating it to changes in the hypothalamic LHRH, pituitary gonadotropins and testicular inhibin/activin. Hypothalamus, pituitary-hypothalamus complex (PHC) and intact pituitary (PI) from control and tamoxifen-treated male rats were superfused in vitro, and pulsatile release of LHRH by hypothalamus and that of LH and FSH by the PHC and PI were studied. Concomitantly, testicular immunoexpression of alpha and betaB subunits of inhibin/activin were studied by immunohistochemistry and enzyme-linked immunosorbent assays (ELISA). At 0.4 mg/kg/day dose of tamoxifen a decrease in mean hypothalamic LHRH and LH pulse frequency from PHC construct was observed. FSH pulse frequency was not affected under the same experimental conditions. At the same dose of tamoxifen, testicular expression of both alpha and betaB subunits of inhibin/activin was upregulated. The study demonstrated that reduced circulating LH levels were due to a decrease in hypothalamic LHRH concentration and in LH pulsatility following tamoxifen treatment. The lack of effect on circulating FSH under the same experimental conditions was likely due to its modulation by inhibin and activin.

A study of the haematologic spectrum of myelodysplastic syndrome.

In 31 patients of myelodysplastic syndrome, RAEB-t was the commonest subtype (29%), and RARS, the lease common (6.4%); 19.4% were characterised as the unclassifiable (UC) group. Pallor was the dominant sign (90.3%). Low haemoglobin in RA & RARS (p<0.05), thrombocytopenia in RAEB-t (p<0.01) and high leuco/monocyte counts in CMML (p<0.001) were observed. Neutropenia occurred most frequently in RAEB & RAEB-t and circulating blasts in all cases of RAEB-t and CMML. Bicytopenia was the commonest finding (58.1%) and pancytopenia the least (16.1%). 84% of marrows were hypercellular and trilineage dysplasia was seen in 68% of patients. Megaloblastoid dyserythropoiesis was the predominant feature in all cases, dysgranulopoiesis in all cases of RAEB, RAEB-t and CMML, and micromegokaryocytes in all cases of RARS, RAEB & CMML were seen. RAEB-t and RAEB (33.3% each) were the predominant groups which progressed to leukemia, FAB AML-M2, being the commonest type (60%).

Pancreatic cancer. Cytologic study of peritoneal washings.

OBJECTIVE: To delineate the frequency and significance of free cancer cells in the peritoneal cavity of patients with pancreatic exocrine adenocarcinoma. DESIGN: Randomly selected patients with pancreatic cancer had peritoneal washings performed at the beginning and conclusion of laparotomy. Results of cytologic studies were correlated with the clinical findings, size, spread, and resectability of the tumor and with the survival time of the patient. All patients were followed up until the present or until their deaths. SETTING: Tertiary care, referral hospitals in Toledo, Ohio. PATIENTS: Only patients with biopsy-proven adenocarcinoma of the pancreas were included. Thirty-six patients, yielding 62 specimens for cytologic study, were included. INTERVENTION: Peritoneal washings were performed at the beginning and completion of laparotomy. Each washing was evaluated independently by two skilled cytologists. If present, ascites was quantitated and studied cytologically. Biopsy specimens were obtained in each patient at the time of the study. MAIN OUTCOME MEASUREMENTS: Presence or absence of malignant cells in peritoneal fluid; maximal diameter, grade, and spread of cancer; presence and volume of ascitic fluid; resectability of cancer; and length of survival of the patient. RESULT: Of the 36 patients studied, three had positive cytologic findings. All three had peritoneal carcinomatosis. Of 11 patients with ascites, only one had positive cytologic findings. CONCLUSIONS: Results of cytologic studies of peritoneal washings or of ascitic fluid are seldom positive with pancreatic exocrine carcinoma. When positive, they denote a very grave prognosis.

Case report 802: Ewing's tumor of the proximal phalanx of the third finger with radiographic progression documented over a 6-year-period.

In summary, a case of Ewing's tumor of the proximal phalanx of the long finger of the right hand was presented. This case is unusual because of its location as well as the unusually long clinical course before the correct diagnosis was made. The major point to be stressed is that Ewing's tumor may initially present with a "benign" appearance mimicking a bone cyst [17] or angioma [12]. Timely follow-up of so-called benign lesions, particularly when recurrent swelling occurs, would help in avoiding prolonged delays in diagnosis.

Primary congenital rhabdoid tumor of the brain with neoplastic hydranencephaly.

A child with shunted hydranencephaly and presumed ventriculitis was found to have a primary congenital rhabdoid tumor (RT) of the brain. The child died and a complete autopsy was carried out. The cerebral hemispheres were replaced by a single thin-walled cavity studed with tumor nodules and filled with thick, viscous fluid. The posterior fossa and visceral organs were free of tumor. This case is unique because the rhabdoid tumor was primary to the brain, it was congenital, and it massively replaced the cerebral hemispheres, causing hydranencephaly. Only three other cases of primary RT of the brain with complete autopsy examination have been reported. Cases of congenital rhabdoid tumors are not known in the literature. Hydranencephaly with a highly proteinaceous fluid should alert the physician to the possibility of a neoplasm. When the fluid in presumed ventriculitis is sterile, cerebral biopsy should be considered.

Group A variants defined with a monoclonal anti-A reagent.

Unusual serologic findings mimicking the B(A) phenomenon were noted in two group B blood donors using blended murine monoclonal anti-A reagent. With additional studies, including a binding experiment using affinity chromatography, the presence of aberrant group A activities was confirmed. This observation suggests that persons with atypical B(A) phenotype may warrant further investigation to delineate the ABO blood group.