Acquired uterine arteriovenous malformation developing in retained products of conception: a diagnostic dilemma.

Abnormal uterine bleeding in the postabortal period requires meticulous diagnostic work-up to decide proper management. Imaging modalities including Doppler sonography and magnetic resonance imaging in concert with clinical and laboratory findings are useful to narrow the differential diagnoses but are not definitive. Presence of increased uterine vascularity and arteriovenous shunting is non-specific and can be detected in a variety of conditions including retained trophoblastic tissue, gestational trophoblastic disease, arteriovenous malformation (AVM), placental polyp and vascular neoplasm. We present here a case of a multiparous woman with unexplained postabortal bleeding posing a diagnostic challenge. Excluding the possibility of AVM before attempting dilatation and curettage in such a clinical scenario is crucial to prevent catastrophic bleeding.

Assessment of Status of rpoB Gene in FNAC Samples of Tuberculous Lymphadenitis by Real-Time PCR.

Introduction. Multidrug resistance tuberculosis (MDR TB), the combined resistance of Mycobacterium tuberculosis to isoniazid (INH) and rifampin (RFM) is a major public health problem in India as it ranks second among the MDR-TB high burden countries worldwide. WHO recommends RFM resistance as a "surrogate marker" for detecting MDR. FNAC is the most widely used noninvasive investigative technique for TB lymphadenitis. Real-time polymerase chain reaction, an extremely versatile technique can be used for the timely detection and treatment of MDR TB by assessing RFM resistance status in the FNAC samples of TB lymphadenitis. Aim. To assess the status of rpoB gene by real-time PCR in FNAC samples of TB lymphadenitis. Materials and Methods. Thirty FNAC samples from patients with persistent LAP or appearance of new LAP after 5 months or more of Anti Tubercular Treatment were assessed for status of rpoB gene by Real-Time PCR using probe covering the "hot spot resistance" region of the rpoB gene. Result. By using probe covering codons 531 and 526 of rpoB gene, we could detect 17 of 30 (56.7%) rifampin resistant isolate. The PCR could detect Mtb DNA in 100% of cases. Conclusion. Use of molecular methods like Real-Time PCR for detection of MDR-TB in FNAC samples is time saving, logical and economical approach over the culture based method.

Multicentric extraskeletal myxoid chondrosarcoma of uterine adnexa in a young female: an unusual presentation.

Extraskeletal myxoid chondrosarcoma is a rare soft-tissue sarcoma, mostly occurring in the proximal extremities and limb girdle. Majority of the patients are in fifth and sixth decades of life with male preponderance. We report here a case of primary extraskeletal myxoid chondrosarcoma of the uterine adnexa involving the broad ligament and fallopian tube synchronously without any evidence of uterine/ovarian involvement in a young multiparous female of 27 years. After the histopathological diagnosis, re-excision of the tumor bed with wide local margins was recommended. Since the tumor has an aggressive course, with propensity for late recurrence and metastases to lungs, the patient must be considered for long-term follow-up.

BCG reaction in twin newborns: effect of zygosity and chorionicity.

OBJECTIVE: To study local response to BCG vaccination in twin babies and find out the effect of zygosity andchorionicity on BCG uptake. DESIGN: Analytical observational study. SETTING: Tertiary hospital. METHODS: Twin pairs born in the hospital were evaluated for zygosity and chorionicity. BCG vaccination was given within 48 hours of birth to babies >/=33 weeks of gestation and birth weight >/= 1500 g. Follow-up was done at 6,10 and 14 weeks. Local response to BCG vaccination was recorded in the form of no reaction, abortive reaction, papule, pustule, ulcer, scab or scar. RESULTS: One hundred thirty three twin pairs were delivered (16 monochorionic, 117 dichorionic); of which zygosity was determined in 110 pairs (81 dizygotic, 29 monozygotic). Two hundred four twin babies qualified for BCG vaccination. After 14 weeks, local reaction was seen in 84.3% babies and scar formed in 41.2% cases. Five abortive reactors and 20 'true non-reactors' were also found. Intra-pair agreement for local BCG reaction was highly significant in both monozygotic/dizygotic, as well as monochorionic/dichorionic twins (P<0.01). However, monozygotic and monochorionic intrapair agreements were not significantly larger than the dizygotic and dichorionic intrapair agreements(P >/= 0.05), respectively. CONCLUSION: Local response to BCG vaccination in twin newborn babies follows same pattern as singletons and there is no effect of zygosity or chorionicity on the uptake.

Evaluation of clinico-radiological, bacteriological, serological, molecular and histological diagnosis of osteoarticular tuberculosis.

BACKGROUND: The diagnosis of osteoarticular tuberculosis is clinico-radiological in endemic areas. However every patient does not have the classical picture. Osteoarticular tuberculosis is a paucibacillary disease hence bacteriological diagnosis is possible in 10-30% of the cases. The present study is undertaken to correlate clinico-radiological, bacteriological, serological, molecular and histological diagnosis. MATERIALS AND METHODS: Fifty clinico-radiologically diagnosed patients of osteoarticular tuberculosis with involvement of dorsal spine (n = 35), knee (n = 8), shoulder (n = 1), elbow (n = 2) and lumbar spine lesion (n = 4), were analyzed. Tissue was obtained after decompression in 35 cases of dorsal spine and fine needle aspiration in the remaining 15 cases. Tissue obtained was subjected to AFB staining, AFB culture sensitivity, aerobic/anaerobic culture sensitivity histopathological examination and polymerase chain reaction (PCR) using 16srRNA as primer. Serology was performed by ELISA in 27 cases of dorsal spine at admission and one and three months postoperatively. RESULTS: AFB staining (direct) and AFB culture sensitivity was positive in six (12%) cases. Aerobic/anaerobic culture sensitivity was negative in all cases. Histology was positive for TB in all the cases. The PCR was positive in 49 (98%) cases. All dorsal spine tuberculosis cases showed fall of IgM titer and rise of IgG titer at three months as compared to values at admission. CONCLUSION: Histopathology and PCR was diagnostic in all cases of osteoarticular tuberculosis. The serology alone is not diagnostic.

Sertoli-Leydig cell tumor of ovary with heterologous element: a case report.

Sertoli-Leydig cell tumors are uncommon tumors of ovary accounting for about 1% of sex cord stromal tumors. They constitute between 0.1% to 0.5% of all the primary ovarian neoplasms. The majority of reported cases are moderately or poorly differentiated combined Sertoli-Leydig cell tumors. A rare case of Sertoli-Leydig cell tumor with heterologous element in a 14 year girl is described. The heterologous component comprised smooth muscle, an uncommon element, that was seen in 60 to 70% of the tumor area. The epithelial element of the tumor consisted of solid, tubular and foci of retiform pattern. Both these features imply a poor prognosis.

Spindle-cell hemangioendothelioma of the posterior pharyngeal wall.

Spindle-cell hemangioendothelioma is an uncommon vascular lesion that exhibits a predilection for the extremities. Very few reports have been published describing this lesion in the head and neck, and to the best of our knowledge, its occurrence in the oropharynx has not been previously reported In addition to reporting an unusual site of this lesion, our rationale for publishing this case is to comment on the diagnostic dilemma that arose in view of an unclear clinicohistopathologic pattern and to discuss this lesion similarity to other aggressive tumors.

Aspiration cytology, histology and hormone status in solid and cystic papillary tumor of pancreas--report of three cases.

Solid and cystic papillary tumor of pancreas (SCPT) are rare tumors. Of the well described cases 95% have occurred in women of reproductive age, suggesting a role of hormonal factors in the pathogenesis of this tumor. Only few studies evaluating estrogen and progesterone receptor status have found it to be positive. Cytohistocorrelation and immunohistochemistry for estrogen (ER) and progesterone (PR) receptors of three such cases are reported here. All three were diagnosed by fine needle aspiration cytology (FNAC) and showed cytoplasmic positivity for ER and PR receptors. May-Grunwald Giemsa, Papanicolaou and hematoxylin and eosin stained slides were evaluated for cytology and histopathology. Unstained methanol fixed slides were used for immunohistochemistry. The cytoplasmic staining of ER and PR receptors cannot be underestimated, as shown by Carbone A et al which represents ERII receptors. This study confirms the presence of ER and PR receptors in these tumors and highlights the already established cytological features.

Postmenopausal bleeding: squamous cell carcinoma of cervix with coexisting endometrial tuberculosis.

CASE REPORT: A case of squamous cell carcinoma of cervix co-existent with endometrial tuberculosis presenting as postmenopausal bleeding is being reported for its rarity. The atrophic postmenopausal endometrium is thought to be poorly supportive of tubercle bacilli. Following a radical Wertheim's hysterectomy patient had a hectic postoperative period, which responded to antitubercular treatment. Diagnosis of tuberculosis in this case was made on histopathology postoperatively and confirmed by polymerase chain reaction (PCR) on scrapes from the granulomas obtained by microdissection. CONCLUSION: Tuberculosis complicating malignant disease may occur in regions with a high prevalence of disease; with a resurgence of tuberculosis worldwide this association may not be uncommon. The diagnosis and treatment of tuberculosis in a patient with cancer assumes importance as a high mortality has been seen in patients with co-existent disease.

Fibrous histiocytoma in primary pterygium.

Fibrous histiocytoma, a mesenchymal tumor, although reported to develop in various ocular structures with a variable frequency, has never been found within a pterygium. We report the case of a 50-year-old female who had had a pterygium for the last six years and had developed a tumor within it one and a half years ago. The tumor was excised along with the pterygium. On histopathological examination the tumor was found to be a benign fibrous histiocytoma arising from within the pterygium.

Chronic epididymitis (epididymal nodule) mimicking an adenomatoid tumor--case report with review of literature.

AIM: To describe and review the differential diagnosis of epididymal nodules and chronic epididymitis so as to have a broad view of this pathology. We have suggested a possible diagnostic algorithm for the workup of an epididymal nodule. METHODS/RESULTS: We have reported a case of a 35-year-old patient with a symptomatic palpable nodular mass in the tail of the left epididymis. Fine needle aspiration suggested an adenomatoid tumor while the surgical excision histology was reported as chronic epididymitis. CONCLUSIONS: Epididymal nodules are frequently encountered in the epididymis. Their differential diagnosis includes chronic granulomatous epididymitis, adenomatoid tumor and benign paratesticular neoplasms. We consider that it is important to distinguish epididymal nodules from benign inflammatory lesions and the threshold for a surgical excision should be low as it is therapeutic and provides a definite diagnosis. Whilst the FNAC alone may not be always adequate to confirm diagnosis, an epididymectomy may be curative as well as diagnostic in selected cases.