A 25-year-old woman, third gravid, with previous two miscarriages presented to the emergency at 17 weeks 2 days of gestation with complaints of pain in the abdomen for 1 day and decreased urine output for 2 days. She was in shock. There was no history of bleeding per vaginum, trauma, surgical procedure or medical illness. Her obstetrical history was marked by a spontaneous second trimester miscarriage at 24 weeks that was followed by fever for 1 week. Ultrasound revealed an extra uterine fetus with sac en caul secondary to uterine rupture. She was resuscitated and taken up for emergency salvage laparotomy. The ragged fundal rent was excised and uterine reconstruction was performed. Histology revealed placenta percreta. The patient had a rapid recovery.
Background and Aim:
Several studies have reported the performance of combining endoscopic ultrasound fine-needle aspiration with an echobronchoscope (EUS-B-FNA), with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), for the diagnosis of mediastinal lymphadenopathy. Herein we report our initial experience with this technique.
Patients and Methods:
In this retrospective study, we report the outcome of patients who underwent EUS-B-FNA with or without EBUS-TBNA during the same session. Details of the lymph nodes sampled, number of passes, duration of the procedure, results of the cytological examination, and the final diagnosis of all the patients are presented.
Eleven patients underwent EUS-B-FNA during the study period. EUS-B-FNA and EBUS-TBNA together yielded a sensitivity and specificity of 72.7 and 100%, respectively. The number of lymph nodes sampled per patient and the number of passes per lymph node were significantly higher with EBUS-TBNA compared to EUS-B-FNA. The mean duration of procedure was also significantly higher in the EBUS-TBNA group. The most common reason (five patients (45.5%)) for resorting to EUS-B-FNA was the patient being unfit for EBUS-TBNA or the inability of the operator to complete the procedure. Sarcoidosis was the most frequent final diagnosis in the study patients (four cases), followed by bronchogenic carcinoma (three cases).
EUS-B-FNA is a useful additional tool for the diagnosis of mediastinal lymphadenopathy. In combination with EBUS-TBNA, it has a fairly good diagnostic yield and is a good alternative in situations where EBUS-TBNA is not feasible.
Bronchoscopy; EBUS; lung cancer; sarcoidosis; TBNA; transbronchial needle aspiration; tuberculosis
Incorporation of orthogonal functional groups into biodegradable polymers permits the fabrication of multi-layered thin films with improved adhesion and tunable degradation profiles. The bi-layer structure also allows for accurate control over small molecule release.
Cervical sample is routinely taken to identify squamous dysplastic lesions of the cervix. Glandular lesions are far less commonly reported on cervical samples. The most common glandular lesion reported on cervical smear is endocervical adenocarcinoma, followed by endometrial adenocarcinoma. Direct sampling by Cervex brush is possible even in endometrial adenocarcinoma, if the tumor directly involves lower uterine segment/endocervical canal. Metastases to cervix are rare but have occasionally been reported in previous reports. We wish to highlight in this case, metastatic ovarian carcinoma directly sampled in cervical liquid-based cytology (LBC) sample, which mimicked cytomorphologically a well-differentiated endocervical adenocarcinoma. To the best of our knowledge, a similar case has not been previously published in SurePath LBC sample.
Cervical sample; direct sampling; liquid based cytology; metastasis; ovarian carcinoma
Penile metastasis secondary to primary bladder cancer is a rare entity and represents a challenging problem. The common mode of spread to the penis is by retrograde venous route. The overall outcome is dismal and most patients will die within 1 year even after optimum treatment. Here, we report two such cases.
Carcinoma Urinary Bladder; Penile metastasis; Radiotherapy
Parvovirus B19 infection can present with myriads of clinical diseases and syndromes; liver manifestations and hepatitis are examples of them. Parvovirus B19 hepatitis associated aplastic anemia and its coinfection with other hepatotropic viruses are relatively underrecognized, and there is sufficient evidence in the literature suggesting that B19 infections can cause a spectrum of liver diseases from elevation of transaminases to acute hepatitis to fulminant liver failure and even chronic hepatitis. It can also cause fatal macrophage activation syndrome and fibrosing cholestatic hepatitis. Parvovirus B19 is an erythrovirus that can only be replicate in pronormoblasts and hepatocytes, and other cells which have globosides and glycosphingolipids in their membrane can also be affected by direct virus injury due to nonstructural protein 1 persistence and indirectly by immune mediated injury. The virus infection is suspected in bone marrow aspiration in cases with sudden drop of hemoglobin and onset of transient aplastic anemia in immunosuppressed or immunocompetent patients and is confirmed either by IgM and IgG positive serology, PCR analysis, and in situ hybridization in biopsy specimens or by application of both. There is no specific treatment for parvovirus B19 related liver diseases, but triple therapy regimen may be effective consisting of immunoglobulin, dehydrohydrocortisone, and cyclosporine.
Hemangiomas of the pericardium are very rare primary pericardial tumours. Very few cases of pericardial hemangioma have been reported in the literature till date. We are reporting a case of a 40 years old male who presented with the complaints of chest discomfort and palpitation on exertion, of 3 months duration. ECHO and Colour Doppler ECHO which were done, revealed a large heterogeneous mass which measured 7.6 × 7.1cms, which was possibly attached to the roof and the anterior surface of the left atria, which was possibly a myxoma. Based on the radiological findings, a diagnosis of left atrial myxoma was considered. However, intra operatively, an encapsulated mass was seen within the pericardium, which was successfully excised and sent for histopathology. The histopathological examination revealed an intrapericardial hemangioma. This case has been reported on account of its extreme rarity.
Hemangioma; Intrapericardial hemangioma; Myxoma
Fungal microorganisms as a cause of gastric perforation, is very rare. Most of the cases of gastric perforation are seen as the complications of peptic ulcer disease, the intake of NSAIDs (Non Steroidal Anti-Inflammatory Drugs), neoplastic diseases, etc. We are reporting a case of a 50 year old male who presented with a sudden onset of abdominal pain and shock and was diagnosed as acute peritonitis which was caused by a gastrointestinal perforation. An emergency exploratory laporotomy was performed and a gastric perforation repair with omentoplexy was done. However, the patient died in the post operative period due to a sudden cardiac arrest. A gastric perforation edge biopsy revealed the presence of fungal hyphae. The peritoneal fluid culture revealed Candida albicans colonies.
Gastric perforation; Fungal infection; Candida perforation
Allyl glycidyl ether, polymerized from potassium alkoxide/naphthalenide initiators under both neat and solution conditions was shown to be a highly-controlled process. In both cases, molar masses (10–100 kg/mol) were determined by the reaction stoichiometry, and low polydispersity indices (1.05–1.33) could be obtained with a full understanding of the dominant side reaction, isomerization of the allyl side chain, being developed. The degree of isomerization of allyl to cis-prop-1-enyl ether groups (0 – 10 % mol.) was not correlated to the molar mass or polydispersity of the polymer but was dictated by the polymerization temperature. This allows the extent of isomerization to be reduced to essentially zero under either melt or solution conditions at polymerization temperatures of less than 40 °C.
polyethers; ring-opening polymerization; anionic polymerization
Endometriosis is the presence of endometrial tissue outside the Uterus. The true incidence of endometriosis is not really known, but it is believed that 10-15% of all women in their reproductive age will develop endometriosis and 25-35% of all women who are infertile have endometriosis. Incisional endometriosis (IE) is a rare entity reported in 0.03-1.08% of women following obstetric or gynaecologic surgeries. Most cases reported in literature have appeared after caesarean sections and were often clinically mistaken for hernia, abscess, suture granuloma or lipoma. The diagnosis is frequently made only after excision of the diseased tissue. A case report of a patient with a painful troublesome scar after a caesarean section is presented.
Endometriosis; incisional endometriosis; painful scar; scar endometriosis
Parotid gland involvement in tuberculosis is rare. We present a case of middle aged male presenting with parotid swelling for 1 year and diagnosed to have parotid tuberculosis on fine needle aspiration cytology. A brief review of radiological findings in tuberculous parotitis is discussed which can help in correct interpretation and timely diagnosis, and thus avoiding unnecessary parotidectomies.
Cytology; parotid; tuberculosis
Premature ovarian failure is defined as the loss of functional follicles below the age of 40 years and the incidence of this abnormality is 0.1% among the 30–40 years age group. Unexplained POF is clinically recognized as amenorrhoea (>6 months) with low level of oestrogen and raised level of Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH > 20 IU/l) occurring before the age of 40. It has been studied earlier that chromosomal defects can impair ovarian development and its function. Since there is paucity of data on chromosomal defects in Indian women, an attempt is made to carry out cytogenetic evaluation in patients with ovarian failure. Cytogenetic analysis of women with ovarian defects revealed the chromosome abnormalities to be associated with 14% of the cases analyzed. Interestingly, majority of the abnormalities involved the X-chromosome and we report two unique abnormalities, (46,XXdel(Xq21-22) and q28) and (mos,45XO/46,X+ringX) involving X chromosome in association with ovarian failure. This study revealed novel X chromosome abnormalities associated with ovarian defects and these observations would be helpful in genetic counseling and apart from, infertility clinics using the information to decide suitable strategies to help such patients.
Fibromatosis form a spectrum of clinicopathologic entities characterized by the infiltrative proliferation of fibroblasts that lack malignant cytologic features. The fibromatosis can be localized or infiltrative and multicentric and can involve internal tissues and organs as the mesentery, retroperitoneum, breast, and almost every organ and region of the body, including the bones, the meninges and the central nervous system. We report a case of 37-year-old male who presented with a right supraclavicular mass with superficial infiltrative type of fibromatosis and fine needle aspiration cytology (FNAC) was performed. We report this case because of limited literature of FNAC in fibromatosis and quick role of FNAC in the diagnosis of fibromatosis.
Fibromatosis; fine needle aspiration cytology; soft tissue lesions
Primary lymphoma is an uncommon malignancy of the thyroid, comprising of 0.6 to 5 per cent of thyroid cancers in most series. Primary thyroid lymphomas (PTL) occur most commonly in elderly women and are commonly of B- cell origin. These frequently present in clinical stage IE and IIE. We report here ten cases of PTL diagnosed over a period of about 7 years in our institute. Out of these ten cases, nine were diagnosed on fine needle aspiration cytology (FNAC) and one case was misdiagnosed as lymphocytic thyroiditis. This case was diagnosed as Non- Hodgkin's lymphoma on surgical specimen. Five patients are disease free and doing well, while two died of disease and the other two were lost to follow-up. One patient is currently on chemotherapy. The salient clinical, biochemical, radiological features, FNA findings along with diagnostic difficulties are discussed.
Primary thyroid lymphoma; Fine needle aspiration cytology; Prognosis.
Bacillus Calmette Guerin (BCG) lymphadenitis is a well known entity. Disseminated BCG infection usually presents as generalized lymphadenopathy, skin rash and hepatosplenomegaly and at times, can pose a diagnostic challenge to clinicians. There are only a few published studies on the cytological findings of BCG lymphadenitis. In this letter we report the fine needle aspiration cytology (FNAC) of BCG lymphadenitis clinically masquerading as Langerhans cell histiocytosis (LCH). FNA smears showed sheets of foamy macrophages and many polymorphs in a dirty necrotic background with many macrophages as well as polymorphs showing negatively stained rod like structures within their cytoplasm. Zeihl Neelson stain revealed that these cells were heavily loaded with acid fast bacilli (AFB). In the index case, AFB were also seen within the cytoplasm of polymorphs, which has not been documented earlier in the literature.