Reconnoitre ameloblastic carcinoma: A prognostic update.

Giant breast masses are entities of great concern as they continue to pose a diagnostic as well as a therapeutic challenge We present a case of giant fibroadenoma of the right breast in a year old woman which simulated as a phyllodes tumor creating a diagnostic conundrum

/pdf/giant-fibroadenoma-of-breast-a-diagnostic-dilemma-in-a-38jec8hr22.pdf

Giant fibroadenoma of breast: a diagnostic dilemma in a middle aged woman

Eosinophilia is an uncommon manifestation in Rheumatoid arthritis (RA), and there is a paucity of data regarding the relationship of eosinophilia with disease-related factors. We prospectively evaluated the clinical and disease-specific characteristics of RA patients with eosinophilia. Consecutive patients with RA with an absolute eosinophil count ≥ 500/mm3 without an apparent cause for eosinophilia, were investigated for parasitic infestation. Patients with a definite parasitic infestation received targeted therapy, and the rest were treated with albendazole empirically. The RA disease-specific characteristics of the patients with persistent eosinophilia were compared with the patients without eosinophilia. Of the 160 patients with eosinophilia, 30 patients (19%) had allergic diseases, six patients had bronchiectasis, and one patient had hypereosinophilia of undetermined significance. Intestinal helminthiasis was found in 34 patients (21%). Eosinophilia was unexplained in 89 patients (56%) and it resolved after empirical albendazole therapy in about two-thirds (58 patients). Thirty-one patients had persistent eosinophilia. Nonsteroidal anti-inflammatory drug and disease-modifying antirheumatic drug modification did not show any effect on eosinophilia. The disease-related characteristics were similar between patients with persistent eosinophilia and those without eosinophilia. Eosinophilia is due to secondary causes in the majority of RA patients, and the most common cause in our setting is an intestinal helminthic infection. Persistent eosinophilia in our cohort of RA did not indicate a more severe disease phenotype.

Persistent eosinophilia in rheumatoid arthritis: a prospective observational study

Eosinophilic granulocytes are normally present in low numbers in the bloodstream. Patients with an increased number of eosinophilic granulocytes in the differential count (eosinophilia) are common and can pose a clinical challenge because conditions with eosinophilia occur in all medical specialties. The diagnostic approach must be guided by a thorough medical history, supported by specific tests to guide individualized treatment. Neoplastic (primary) eosinophilia is identified by one of several unique acquired genetic causes. In contrast, reactive (secondary) eosinophilia is associated with a cytokine stimulus in a specific disease, while idiopathic eosinophilia is a diagnosis by exclusion. Rational treatment is disease-directed in secondary cases and has paved the way for targeted treatment against the driver in primary eosinophilia, whereas idiopathic cases are treated as needed by principles in eosinophilia originating from clonal drivers. The vast majority of patients are diagnosed with secondary eosinophilia and are managed by the relevant specialty—e.g., rheumatology, allergy, dermatology, gastroenterology, pulmonary medicine, hematology, or infectious disease. The overlap in symptoms and the risk of irreversible organ involvement in eosinophilia, irrespective of the cause, warrants that patients without a diagnostic clarification or who do not respond to adequate treatment should be referred to a multidisciplinary function anchored in a hematology department for evaluation. This review presents the pathophysiology, manifestations, differential diagnosis, diagnostic workup, and management of (adult) patients with eosinophilia. The purpose is to place eosinophilia in a clinical context, and therefore justify and inspire the establishment of a multidisciplinary team of experts from diagnostic and clinical specialties at the regional level to support the second opinion. The target patient population requires highly specialized laboratory analysis and therapy and occasionally has severe eosinophil-induced organ dysfunction. An added value of a centralized, clinical function is to serve as a platform for education and research to further improve the management of patients with eosinophilia. Primary and idiopathic eosinophilia are key topics in the review, which also address current research and discusses outstanding issues in the field.

/pdf/the-multidisciplinary-approach-to-eosinophilia-3nl2jxte.pdf

The multidisciplinary approach to eosinophilia

中枢神经系统的胶质神经元肿瘤是含有肿瘤性神经元和胶质两种成分的神经上皮肿瘤,但不包括可以向神经细胞和胶质双向分化的胚胎性肿瘤[1-6].胶质神经元肿瘤较少见,其中相对常见的是节细胞胶质瘤,而胚胎发育不良性神经上皮肿瘤、促纤维增生性婴儿节细胞胶质瘤以及近年来陆续报道的一些具有形态特点的新的胶质神经元肿瘤,如乳头状胶质神经元肿瘤[7]和伴有神经毡样岛或菊形团的胶质神经元肿瘤[8],都是少见的类型。

[Dysplastic gangliocytoma of cerebellum (Lhermitte-Duclos disease)].

Ameloblastic carcinoma (AC) is a rare epithelial odontogenic tumor of the jaws, which exhibits cytological features of ameloblastoma and carcinoma. It has a distinct predilection for mandible. These lesions may initially show histologic features of ameloblastoma that dedifferentiate over time. Others may present with features of epithelial dedifferentiation in ameloblastoma. A case of ameloblastomic carcinoma in a 64-year-old male is reported, who presented with swelling in the left mandible 3 months after the extraction of the left upper molar.

Ameloblastic carcinoma: A case report and literature review.

BACKGROUND- Eosinophilia is abnormally high number of eosinophils in the blood. Normally, eosinophils constitute 1 to 6% of the peripheral blood leukocytes, at a count of 350 to 650 per cubic millimeter. Eosinophilia can be categorized as mild (less than 1500 eosinophils per cubic millimeter), moderate (1500 to 5000 per cubic millimeter), or severe (more than 5000 per cubic millimeter). Eosinophilia may be primary or secondary. The aim of the study was to determine the incidence of eosinophilia and evaluate the patients thoroughly for the cause of eosinophilia. METHOD- The study was conducted in the Pathology department in the medical college and hospital in rural are of Punjab. Complete blood count and peripheral blood film study was done in almost all the patients visiting the hospital. The patients with eosinophilia were segregated and were made to fill the detailed proforma. The information included family history, chief complaints, food habits, disease history  and drug history. A thorough general examination and diagnostic work up followed. RESULT- In all 3442 (10.7%) patients visiting the hospital had eosinophilia; out of this 2136 (62%) patients had mild eosinophilia, 1297 (37.7%) had moderate and 9 (0.3%) had severe eosinophilia. 2451(71.2%) patients were males and 991 (28.8%) were females. Age group of patients varied from 3 yrs to 74 yrs. The chief complaints of our patients were related to  fever, cough, rashes, breathlessness, wheezing etc.  other major group of patients had symptoms of abdominal pain, diarrhea, pallor, pica and loss of appetite. CONCLUSION- Eosinophilia appears to be a common occurrence in the in the rural population around our hospital. The most common etiologies were due to parasitic, protozoal or fungal  infestations and infections. Allergy related problem also constituted a significant health problem in the local population. DOI: 10.21276/apalm.2017.1044

/pdf/incidence-of-eosinophilia-in-rural-population-in-north-india-68knopu5gh.pdf

Incidence of Eosinophilia in Rural Population in North India: A Study at Tertiary Care Hospital

Papillary carcinoma of the uterine cervix with features reminiscent of Transitional Cell Carcinoma (TCC) of urothelial origin, is a poorly recognized subtype of cervical carcinoma. This tumour has a propensity for late metastasis and local recurrence, in spite of the fact that histologically it could be misinterpreted as CIN grade III with a papillary configuration or as a squamous cell papilloma. This tumour occurs mainly in post-menopausal females, it is potentially aggressive and it presents at a more advanced stage. Here, we are presenting a case of a 65-year-old female who presented with post-menopausal bleeding and pelvic pain, and underwent hysterectomy for pyometra. The cervix showed a focus of papillary transitional carcinoma.

Transitional Cell Carcinoma: A Case Report with Clinical, Histological and Cytological Findings

OBJECTIVE: A rare case of LDD confirmed by biopsy is being reported. Review of the published cases shows that the disease usually manifests by the signs of increased intracranial pressure with inconstant cerebellar symptoms. MRI is the imaging modality of choice by now. As such, clinical problems after gross total or complete removal have not been reported so far, but herein we stress the importance of intraopeartive diagnosis of lesions that have no distinct border between the lesion and normal tissue. METHODS: After subtotal resection of lesion, small representative tissue was sent to pathology department intraoperatively in saline for squash smear cytology and postoperatively, whole tissue was sent in formalin for histopathology. The squash smears were stained with MGG, H&E, and PAP stain and report was rendered within 30 minutes. The morphological details as observed in the smears were correlated with Histopathology findings. RESULTS: Squash smears showed a fibrillary background in most of the smears with scattered ganglion cells having vesicular nuclei and prominent nucleoli. Some of the smears showed small dark granular cells representing internal granular cell layer. The corresponding histopathological findings showed widening of the molecular layer with abnormal myelination that is occupied by abnormal ganglion cells, absence of the Purkinje cell layer and hypertrophy of the granular cell layer. CONCLUSION: Squash smear preparation is a fairly accurate, simple and reliable tool for rapid intraoperative diagnosis of CNS lesions. It is helpful in defining the limits of resection in cases like LDD where margins are not well defined.

/pdf/l-hermitte-duclos-disease-intraoperative-cytological-3izdchiq49.pdf

L hermitte - duclos disease - intraoperative cytological findings of a rare entity

OBJECTIVE: Fibroadenomas are the most common solid lesions of the breast. They typically present as firm, mobile, painless, easily palpable breast nodules. Fibroadenomas measuring 5 cm or more in diameter are considered as giant fibroadenomas which can grow to huge proportions and compress the surrounding normal breast tissue. They can occur in any part of reproductive life of female but are more common before the age of 30 years. CASE REPORT: we report a rare case of Giant fibroadenoma in a postmenopausal female of 52 yr of age. The diagnosis was made on fine needle aspiration cytology and was subsequently confirmed on histopathology. CONCLUSION: Fibroadenoma is an estrogen induced benign tumor common in young female, but in our case it occurred in postmenopausal female, even without any documented estrogen therapy.

/pdf/giant-fibroadenoma-mimicking-phylloides-tumor-a-rare-20x9a1f2ty.pdf

Giant fibroadenoma mimicking phylloides tumor: a rare occurrence in a postmenopausal femal e

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