Primary anaplastic large cell lymphoma of caecum and ascending colon.

Lymphomas are hematological malignancies with a wide variety of histological subtypes, varied clinical manifestations and behaviour and have a wide range of organ involvement. About 40 per cent of lymphomas are extra nodal. The most common extra nodal site is gastrointestinal tract (GIT). In the GIT, stomach is the most common organ involved accounting for 50-60 per cent of the lesions. Colorectal lymphomas are rare and account for 15-20 per cent of GIT lymphomas. They constitute 1 per cent of colorectal malignancies. Most common histological type of lymphoma involving GIT is diffuse large B-cell lymphoma, followed by MALT lymphoma; T-cell lymphomas are very rare and have an incidence of 3 per cent of Non Hodgkins Lymphoma (NHL). We report a case of anaplastic large cell lymphoma in the caecum and ascending colon with review of literature.

Nasal application of petrolatum ointment - A silent cause of exogenous lipoid pneumonia: Successfully treated with prednisolone.

We report a case of exogenous lipoid pneumonia from chronic, extranasal use of petrolatum ointment (Vicks VapoRub in this case) for nasal decongestion in a young woman, presenting with cough, dyspnea and fever. Exogenous Lipoid pneumonia is a rare condition, underdiagnosed and is more prevalent in adults. Usually asymptomatic and diagnosed while evaluating predisposed patients who become clinically unstable or an abnormal lung shadow or during evaluation of rhinobronchial allergy. It is rarely reported from chronic use of petrolatum ointment extranasally and was diagnosed by transbronchial biopsy in the present case. She was found, retrospectively, to have been using petrolatum ointment, as an extranasal application since more than a year at bedtime. She didn't give history of using any other oil-based nasal topical vasoconstrictor preparations for sinusitis. Our patient was managed with discontinuation of further use of the petrolatum ointment and treatment with prednisolone apart from her regular treatment for chronic rhinobronchial allergy. Patient is stable without any further radiological deterioration during follow-up of one year.

Diagnostic utility of bronchoalveolar lavage.

INTRODUCTION: Bronchoalveolar lavage (BAL) is a diagnostic procedure by which cells and other components from bronchial and alveolar spaces are obtained for various studies. One of the main advantages of BAL is that it can be done as a day care procedure. Material obtained by BAL can give a definite diagnosis in conditions such as infections and malignancies. AIMS: The aims and objective of this study were to assess the utility of BAL as a diagnostic tool to determine the diagnostic accuracy of the material obtained from BAL in various infections and neoplastic lesions to study the limitations of BAL in certain lung disorders. MATERIALS AND METHODS: This study was done in a tertiary care center in Hyderabad. Bronchoscopy was done as an outpatient procedure and lavage fluid obtained analyzed. This is a prospective study done from January 2012 to Jun 2013. Ninety-one BALs were analyzed for total and differential count, microbiological examination and cytological evaluation. Cases selected included nonresolving pneumonias, diffuse lung infiltrates, infiltrates in immunosuppressed hosts and ventilator-associated pneumonias. RESULTS: Bronchoalveolar lavage was done in 91 cases over a period of 1½ years. Definite diagnosis was not given in 7 cases. Four cases were inadequate. Tuberculosis was diagnosed in 22 cases, fungal infections in 7 cases. Thirty-eight cases of bacterial pneumonias were diagnosed, Klebsiella was the most common organism. Malignancy was diagnosed in 13 cases. CONCLUSION: Definite diagnosis can be made in tuberculosis, fungal infections, bacterial pneumonias and in malignancies.

Relevance of insulin-like growth factor 2 in the etiopathophysiology of diabetic nephropathy: possible roles of phosphatase and tensin homolog on chromosome 10 and secreted protein acidic and rich in cysteine as regulators of repair.

BACKGROUND: Diabetic nephropathy (DN) is a devastating complication of diabetes, the exact molecular pathophysiology of which is not well established. Hyperglycemia increases insulin-like growth factors (IGFs), especially IGF2, which acts via the IGF1 receptor present on renal cells. Elevated glucose levels damage the kidney, which is repaired by modulators such as secreted protein acidic and rich in cysteine (SPARC). Hence, it was hypothesized that IGF2 and SPARC may have an important role in the etiology of DN. METHODS: Human renal biopsies, histopathologically categorized as normal, early Type 2 diabetes mellitus (T2DM), or established DN, were analyzed for the localization and expression of IGF2, its negative regulator phosphatase and tensin homolog on chromosome 10 (PTEN), and SPARC. RESULTS: Expression of IGF2, PTEN, and SPARC was increased in renal biopsies from T2DM patients compared with normal samples. Although IGF2 protein was increased in biopsies from DN patients, PTEN and SPARC levels were decreased. Real-time reverse transcription-polymerase chain reaction indicated that transcript levels of IGF2 and PTEN were greater than those of ß-actin in all human renal biopsy samples. CONCLUSION: The results suggest the following molecular etiopathophysiology of DN: (i) hyperglycemia upregulates IGF2, which initiates PTEN, a regulator of IGF2 signaling; (ii) loss of this IGF2-PTEN feedback loop causes changes that are characteristic of DN; and (iii) lowered expression of the repair modulator SPARC results in the development and/or progression of DN. Hence, targeting relevant modulators, such as like IGF2, PTEN, and SPARC, may be important in the management of DN.