Primary adenocarcinoma of the upper oesophagus.

Upper oesophageal adenocarcinoma is a rare malignancy that occurs in the ectopic gastric mucosa, in the upper part of the oesophagus. Only 29 cases so far have been reported. We report the 30th case in a 50-year-old Asian female presenting with difficulty in swallowing.

Hemophagocytic syndrome secondary to cytomegalovirus infection in an infant.

Virus associated hemophagocytic syndrome is a non-neoplastic, generalized histiocytic proliferation with prominent hemophagocytosis associated with a systemic viral infection. We report a case of cytomegalovirus (CMV) associated hemophagocytic syndrome in a 2 month old male child presenting with rashes, fever, hepatosplenomegaly, cervical lymphadenopathy and pancytopenia. Fine needle aspiration cytology and biopsy from cervical lymph nodes revealed prominent hemophagocytosis. Serology for CMV IgM was positive in both the mother and the child, suggesting recent infection. Possibly there was intrauterine transmission of the infection.

Cytomorphological spectrum of subcutaneous and intramuscular cysticercosis: A study of 22 cases.

BACKGROUND: Cysticercosis is more common than usually thought. Fine needle aspiration cytology (FNAC) plays an important role in prompt recognition of this disease. AIMS: To study the role of FNAC in the diagnosis of cysticercosis. MATERIALS AND METHODS: Twenty-two patients with subcutaneous and intramuscular nodules, who were clinically diagnosed as tuberculous lymphadenitis, reactive lymphadenitis, lipoma, neurofibroma and cysticercosis were included in the present study. RESULTS: In nine cases, a definitive diagnosis of cysticercosis was obtained in the form of fragments of parasite bladder wall and, biopsy confirmed the diagnosis. In the rest 13 cases, larval fragments could not be identified on the aspirates and the diagnosis of parasitic inflammation was suggested on the basis of other cytomorphological findings. Follow-up biopsy confirmed the diagnosis of cysticercosis. CONCLUSIONS: FNAC in cysticercosis is a low-cost outpatient procedure. The cytological diagnosis is quite straightforward in cases where the actual parasite structure is identified in the smears. However, in other cases, presence of eosinophils, histiocytes which may be in palisaded clusters or not, a typical granular dirty background, etc., are the features which should always alert the pathologist to this possibility.

Role of colour Doppler imaging in detecting prostate cancer.

OBJECTIVE: This prospective study was undertaken to evaluate the role of colour Doppler sonography in the assessment of prostate carcinoma. METHODS: Forty consecutive patients who were suspected of having prostate carcinoma with either raised prostate specific antigen or abnormal digital rectal examination were included in the study. Transrectal greyscale and colour Doppler sonography of the prostate was performed using a 5-9 MHz intracavitary probe. Needle biopsies were taken from areas that showed increased flow on colour Doppler. The results were correlated with the final diagnosis established on histopathological examination. RESULTS: Comparison of greyscale and colour Doppler sonography showed that the latter is more sensitive and specific in predicting the malignancy. The statistical parameters of colour Doppler versus grayscale sonography were: sensitivity 88.23 vs. 73.52, specificity 66.66 vs. 33.33, positive predictive value 93.75 vs. 85.18, and negative predictive value 50 vs. 22.22, respectively. CONCLUSION: Colour Doppler and greyscale sonography should be routinely performed to improve detection of prostate carcinoma and to target the lesion.

Role of ultrasonography and computed tomography in complicated cases of tuberculous cervical lymphadenitis.

AIM: To evaluate complicated cases of tuberculous cervical lymphadenitis by ultrasonography and computed tomography in order to detect more lymph nodes, and to study their lesions. MATERIAL AND METHODS: Total 27 patients of tuberculous cervical lymphadenitis previously proved bacteriologically or histopathologically on anti-tuberculosis treatment (ATT) presenting with complications were taken for study. Each case was subjected to ultrasound (USG) and computed tomography (CT) of involved area. Based on USG and CT findings, patients were subjected to repeat fine needle aspiration cytology (FNAC) of involved lymph node or drainage of pus. RESULTS: On USG, all lesions were hypoechoic and showed necrosis. Other findings were: sharp margins in 70.4 %, hilum in 22.2 %, abnormal surrounding tissue in 85.2 %, matting in 37 %, calcification in 29.6 % and posterior enhancement in 22.2 % patients. On CT, majority of lesions were with central low density (CLD) in 16 (59.3 %), followed by large confluent low density (LCLD) in 7 (25.9 %), multilocular central low density (MCLD) in 4 (14.8 %) and homogeneous soft tissue density (HSTD) in 2 (7.4 %) patients. Necrotising granulomatous lymphadenitis was the most common diagnosis in 17 (63%), followed by necrotising in 6 (22.2 %) and granulomatous in 4 (14.8 %) patients. Fifteen (55.5 %) patients were positive for AFB on ZN smear examination. In 17 patients, culture and sensitivity test for Mycobacterium Tuberculosis from lymph node aspirate was done and 12 (70.6 %) patients were found culture positive. Out of these, 2 (16.7 %) were found to be multi-drug resistant (MDR) cases. CONCLUSION: USG and CT modalities are complementary in diagnosis and management of tuberculous lymphadenitis presenting with complications. USG helps in better localization of site for biopsy/FNAC procedure and drainage of pus with high diagnostic yield. While CT helps in better anatomical localization of lymph nodes not usually detected on clinical examination.

Effect of vitamin A supplementation on hematopoiesis in children with anemia.

Fifty children (1-4 years age) presenting with microcytic hypochromic anemia (hemoglobin less than 10g/dl) were studied in two groups of 25 each. Group I was supplemented with iron (ferrous sulphate 6 mg/kg/d) while group II in addition to iron was also supplemented with vitamin A (5000 IU/d). Hemoglobin concentration was found to be significantly increased after 4 weeks of iron supplementation. Rise in hemoglobin was comparatively more in-group II, as compared to group I, after 8 and 12 weeks. Serum iron was significantly higher after 4 weeks in both the groups. Packed cell volume (PCV) and retinol levels increased significantly in-group II only. The data suggests that supplementation of vitamin A improves hematopoiesis.

Mucormycosis.

A rare case of mucormycosis in a 58 years old healthy house-wife is reported which occurred without any predisposing factors like immuno-suppresion. Etiology, clinical features and treatment is outlined with the caution that the most effective drug i.e. amphotericin B may have very serious side effects as in this case. The disease is acutely fatal and treatment has potential hazards which may prove fatal. However, if the disease entity is kept in mind, with early diagnosis and treatment, the outcome would be quite favourable.