Jejunal mucinous adenocarcinoma: Unusual presentation of a rare pathology.

Mucinous adenocarcinoma of jejunum is a rare tumor of the gastrointestinal tract. Patients usually present after fifth decade of their life with non-specific symptoms. Delayed diagnosis is commonplace and often the reason for advanced disease and poor prognosis. These tumors may masquerade as other common malignancies, with a conclusive diagnosis only after the final histopathological examination. We present a case of jejunal mucinous adenocarcinoma, disguised as cecal malignancy, in an old female patient, managed with radical resection and adjuvant chemotherapy. The report reiterates that the mucinous variant of jejunal adenocarcinoma is a rare pathology with an unusual advanced presentation.

Renal Squamous Cell Carcinoma Presenting With Renohepatic Fistula: A Rare Amalgam.

Background: Primary squamous cell carcinoma (SCC) of the kidney, a rare malignancy that accounts for less than 1% of all urinary tract malignancies, is usually diagnosed in late stages because of the lack of characteristic clinical and imaging features and aggressive behavior. Case Report: A 66-year-old male presented with complaints of right flank pain. Imaging suggested the differential diagnoses of xanthogranulomatous pyelonephritis or renal malignancy extending into segment VI of the liver. Right subcapsular nephrectomy was performed, and nonbilious fluid from the liver cavitary lesions was drained. Histopathologic examination showed that the lesion was a renal SCC with contiguous malignant infiltration of the liver that led to a renohepatic fistula. Conclusion: Renal SCC is a rare high-grade neoplasm and can present in an unusual form with a poor prognosis.

Diagnosis of scar endometriosis on aspiration cytology and cellblock: Myth or reality.

Endometriosis is defined as the presence of endometrial tissue outside the uterus. It can occur both in the pelvic and extra pelvic regions. Abdominal scar endometriosis is a rare type of extra pelvic endometriosis that occurs after surgery involving the uterus. In the post-cesarean section, the development of scar endometriosis is a rare event and the diagnosis of scar endometriosis is usually confirmed after surgical excision and histopathological examination. We present a case of an abdominal lump in a 26-year-old female with a myriad of clinical differential diagnoses, which was rendered a confirmed diagnosis of scar endometriosis with the help of fine-needle aspiration cytology and cell block aided with immunohistochemistry.

Renal angiomyolipoma with epithelial cyst.

Angiomyolipoma with epithelial cysts (AMLEC) is a recently described entity and is an uncommon subtype of kidney angiomyolipomas. AMLEC is a benign entity but usually masquerades a renal cell carcinoma on imaging examination. AMLEC has a distinct histological and immunohistochemical staining pattern, which helps in the pathological diagnosis. We present a rare case of AMLEC in a 26-year-old female, which was provisionally diagnosed as renal cell carcinoma on radiology. We also summarize the differential diagnosis of this rare variant, its characteristic features, and a review of the literature.

Adenocarcinoma of the fourth portion of duodenum presenting as intussusception: an unusual manifestation of rare pathology.

Primary adenocarcinoma of the fourth portion of the duodenum (D-IV) is reported infrequently than other parts of the duodenum. Its diagnosis is often late because of non-specific symptoms and signs. We encountered a 48-year-old male patient who was diagnosed as duodeno-duodenal intussusception, underwent segmental duodenal resection with duodenojejunal anastomosis and confirmed as adenocarcinoma of D-IV. He received adjuvant chemotherapy and is doing well at 1 year of follow-up. This report describes about the rare case of isolated adenocarcinoma of the D-IV presented as intussusception which is never reported before and successfully treated by segmental resection of the duodenum and jejunum.

Crystallising galactocele of the breast: a rare cytological diagnosis.

Galactocele of the breast is a benign condition characterised by milk containing cystic lesions, usually present during pregnancy and lactation. The diagnosis of galactocele is difficult due to physiological changes which occur during pregnancy and lactation. Fine needle aspiration cytology proves to be a simple and minimally invasive procedure in diagnosing and treating this condition. Very rarely, long-standing galactoceles can show crystal formation on aspirate smears, termed as crystallising galactocele. Herein, we present this rare case of crystallising galactocele in a 26-year-old lactating woman. We are reporting this case because of its rarity, as less than 10 cases have been reported so far.

Sarcomatoid urothelial carcinoma of the bladder with osseous metaplasia: bone in urinary bladder.

Sarcomatoid urothelial carcinoma is a rare aggressive malignant neoplasm of the urinary bladder. It usually presents at an advanced stage and thus carries a poor prognosis. These tumours are usually managed with multimodal therapies such as cystectomy and chemotherapy. In the present case, a 72-year-old man presented with gross haematuria and was diagnosed as sarcomatoid urothelial carcinoma with chondrosarcomatous differentiation and extensive stromal osseous metaplasia. The patient was managed with transurethral resection of bladder tumour (TURBT), followed by intravesical chemotherapy. The patient is doing well post 14 months follow-up. Hence, complete TURBT with chemotherapy is also a viable option for patients who prefer to preserve bladder.

Bilateral alveolar rhabdomyosarcoma of breast: a rare entity.

Sarcomas of breast constitute less than 1% of all malignant breast tumours. Alveolar rhabdomyosarcoma (RMS) is very rare in breast with limited case reports in literature, and primary alveolar RMS arising from breast is still less common than metastatic RMS. Here, we report a case of primary bilateral alveolar RMS of breast in an adolescent female where the correct diagnosis was obfuscated by an overlap in the histological features of RMS and high-grade invasive ductal carcinoma.

Renal angiomyolipoma with epithelial cyst

Angiomyolipoma with epithelial cysts (AMLEC) is a recently described entity and is an uncommon subtype of kidney angiomyolipomas. AMLEC is a benign entity but usually masquerades a renal cell carcinoma on imaging examination. AMLEC has a distinct histological and immunohistochemical staining pattern, which helps in the pathological diagnosis. We present a rare case of AMLEC in a 26-year-old female, which was provisionally diagnosed as renal cell carcinoma on radiology. We also summarize the differential diagnosis of this rare variant, its characteristic features, and a review of the literature.

Emergency Pancreatoduodenectomy for Ampullary Cancer Post-Iatrogenic Duodenal Perforation: No Option but to Strike.

Endoscopic retrograde cholangiography related duodenal perforation is an infrequent complication and associated with significant morbidity. The management of such perforations, especially in the setting of malignancy, is not standardized given the paucity of literature. We encountered a patient who was diagnosed with periampullary carcinoma and had a perforation in the duodenum during endoscopy. Emergency pancreatoduodenectomy (EPD) was performed considering it to be a resectable disease with minimal contamination. He had a prolonged hospital course due to surgical site infection and hepaticojejunostomy leak, however, which was managed successfully. At one year follow up, he is healthy with no evidence of recurrence. We conclude that EPD can be attempted for selected iatrogenic duodenal perforations with co-existent resectable malignancy in a stable patient. It may help to avoid the morbidity of a second surgery in the setting of a distorted anatomy and simultaneously preventing the probable upstaging of disease due to peritoneal seedling.

Gallbladder Tuberculosis Presenting as Obstructive Jaundice.

Isolated gallbladder tuberculosis is a rare entity, even in endemic zones. Preoperative diagnosis is usually not possible, with most of the cases being diagnosed either as cholecystitis or malignancy. Histopathological examination of the resected specimen clinches the diagnosis. We present a middle-aged man with obstructive jaundice who was diagnosed to have gallbladder malignancy clinically and radiologically and on microscopy, and was diagnosed as gallbladder tuberculosis with the involvement of the common bile duct.

Mixed neuroendocrine-non-neuroendocrine neoplasms (MiNEN) of pancreas: a rare entity-worth to note.

Mixed adenocarcinoma with neuroendocrine tumour of pancreas has been reported infrequently and consists of both epithelial and neuroendocrine component. We encountered an 81-year-old male patient who presented with clinical features of painful progressive jaundice for 1 month. Contrast-enhanced CT abdomen reported a mass in the pancreatic head with dilated common bile duct and pancreatic duct. He underwent pancreatoduodenectomy and histopathological examination revealed two different tumours: ductal adenocarcinoma admixed with neuroendocrine tumour of pancreas. He received adjuvant chemotherapy, and at the end of 1-year follow-up, he has no recurrence. Here, we reported this rare malignancy of pancreas for which pancreatoduodenectomy was done and diagnosed on histopathology with immunohistochemistry.

Submandibular gland actinomycosis: A rare disease - Worth to mention.

Cervicofacial actinomycosis (AM) is a well-documented entity; however, primary AM of the submandibular gland is infrequent. The diagnosis is difficult due to its nonspecific clinical presentation and it usually mimics chronic granulomatous infection or malignant lesion. We report the case of a young female with AM of submandibular gland, presented as recurrent infection of submandibular gland, underwent its excision and confirmed on microscopy as Actinomyces.

Cutaneous melanoma in childhood presenting as intraparotid lymph node metastasis.

Cutaneous melanoma in childhood is a rare disease. Rendering a clinical diagnosis of melanoma in pediatric patients is confounded by the fact that pigmented lesions in pediatric patients do not conform to the ABCDE rules applicable to adult patients. Furthermore, making a histologic diagnosis of cutaneous melanoma in childhood is also difficult with no universally accepted criteria applicable to pediatric melanomas. We report the case of a 5-year-old child presenting with intraparotid lymph node metastasis who was later found to have melanoma involving periorbital region. It is proposed that careful analysis of histologic features as well as the additional information provided by immunohistochemistry should allow for a correct diagnosis in most cases of melanoma in children.