Sunil Vitthalrao Jagtap

Juvenile fibroadenoma is a rare variant of fibroadenoma and is characterized by rapidly enlarging, painless, and unilateral masses. We presents a case of juvenile fibroadenoma of the breast in a 14 year old girl, presented with rapidly growing mass in the right breast of four months duration. On local examination a solitary, firm, mobile, unilateral, non-tender mass was felt in the upper and lower outer quadrant of the right breast, measuring 6.5 x 4.1 x 3.5cm. The overlying skin was normal. There was no axillary lymphadenopathy. The sonomammography of the right breast showed a single, oval, hypoechoic, well circumscribed mass lesion with cleft like spaces features suggestive of complex fibroadenoma BIRADS IV a. On fine niddle aspiration cytology showed sheets of hyperplastic benign ductal epithelial cells with myoepithelial cells and a background of benign bipolar nuclei and blood, without inflammatory cells. It was suggestive of fibroadenoma. She underwent right lumpectomy with breast conservation. We received right breast lumpectomy specimen. On gross showed a well-circumscribed, grey white, firm mass m 6.3 x 4.1 x 3.2 cm. On histologic features reported as juvenile fibroadenoma right breast. The postoperative period was uneventful and she recovered well and advise regular follow up. Conclusion: Juvenile fibroadenomas are rare benign breast tumors that should be distinguished from other masses of breast. Herewith we are presenting case of Juvenile fibroadenoma for its clinical, radio imaging, pathological features and management.   Keywords: Benign breast tumors, Juvenile fibroadenoma, Mastectomy

Malignancy in giant cell tumor of bone (MGCTB) is extremely rare condition. We reported a case of 45 year female, with gradually increasing swelling over left wrist of 6 months. She was known case of giant cell tumor (GCT) of left radius operated 20 months back. Now on Magnetic Resonance Imaging (MRI) scan showed well defined mass lesion at distal end of forearm suggestive of recurrence of GCT. The excision of mass was done. On histopatholgical examination reported as secondary malignant GCT. We are presenting this case for its clinical, radiological and histopathological findings.   Keywords: Bone tumors, Giant cell tumor, Malignant bone

Background: Nodular fasciitis is rarely reported in breast. It is benign reactive proliferative lesion of fibroblast. Case Report: A 65 year old female presented to surgical department for left breast mass since 2 months duration, rapidly enlarging without any regional lymphadenopathy. Mammography showed hyperdensity masses with irregular margin. On FNAC reported as benign spindle cell lesion. Left sided two breast masses measuring 4 x 3.3 x 2.5cm and 2.0 x 1.6 x 0.5cm were excised and on histopathology reported as Nodular Fasciitis of left breast. Conclusion: We are presenting this extremely rare case of nodular fasciitis of breast for its clinical, radiological and histopathological findings.   Keywords: Benign breast lesions, Stromal tumor, Breast mass, Histopathology

COVID-19 is an infection caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Now there are increased cases with super infections by mucormycosis, which were rarely reported in the beginning of the current pandemic of COVID 19. Herewith a case of 47 year-old male patient of post COVID-19 infection having severe hypoxia and was on ventilator, received steroid treatment and also known case of HIV/AIDS. Now admitted to our hospital having fever, facial pain, and swelling midface region. His RT-PCR test was positive. On clinical, radio imaging and on histopathological findings diagnosed as maxillary mucormycosis. We are presenting this rare case for its clinical, radio imaging, and on histopathological findings. Keywords: COVID19, Mucormycosis, SARSCoV2, maxillary fungal infection.

Abstract A 55 year male patient presented with progressive growth over left lower eyelid measuring 1.5 x 1 cm. The local examination showed ulceroproliferative growth with irregular margins and everted edges. On histopathological examination diagnosed as basal cell carcinoma of lower eyelid. We are presenting this case for its clinical manifestations and histopathological findings. Keywords: Eyelid tumor, Basal cell carcinoma, Pigment. Introduction The prevalence of Basal Cell Carcinoma (BCC) is on rise and it is estimated that every year there is increase in cases by 10% and the lifetime risk or developing BCC is around 30%.[1][2]The various malignant tumours arising from eyelids were reported, BCC accounts for 80 -90% of all malignant lid tumours.[3] The tumours show high rate of recurrence which is mostly related to incomplete surgical resection and involves most of the eye socket and intracranial extension.[4],[5]Histopathological subtype plays an important role in progress of disease. In our case it showed nodular type of BCC. We have studied its clinical behavior and progress. Case Presentation A 55 year old male farmer by occupation presented to plastic surgery unit with complaint of growth over left eyelid of 6 month duration. The growth was measuring 1.5x 1cm with irregular margins, everted edges. The base was formed by a dark brown exudate with areas of blackish incrustation. The surrounding periorbital area shows swelling and oedema. No evidence of any palpable neck nodes. Wide excision of lower lid swelling was done and tissue was sent for histopathology examination. We received the excised specimen of ulceroproliferative growth of lower eye lid totally measuring 2.2 x 1.8x 0.6cm. The growth measured 1.7x 1x 0.4 cm which was grey white, firm. Areas of focal hemorrhages and blackish discoloration was noted (Fig. 1). The surgical margins appear free from growth. Microscopy showed epithelial neoplasm invading deeper tissue (Fig. 2) The tumour was arranged in nodular pattern with islands strands and clusters with peripheral palisidation. (Fig. 3,4). The area of blackish pigmentation was noted. On histopathological the diagnosis was nodular basal cell carcinoma (Fig. 5). The patient underwent wide excision with reconstruction of the defect. On regular followup patient responded well to treatment. Click here to view Fig. 1: growth over left eyelid measuring 1.5x 1cm with irregular margins, everted edges. Click here to view Fig. 2: microscopy showing ulcer and epithelial neoplasm invading deeper tissue. (Haematoxyline & Eosin stain, 40x) Click here to view Fig. 3: microscopy showing the tumour arranged in nodular pattern with peripheral palisidation. (Haematoxyline & Eosin stain, 100x). Click here to view Fig. 4: microscopy showing the tumour arranged in nodular pattern with peripheral palisidation (Haematoxyline & Eosin stain, 40x). Click here to view Fig. 5: microscopy showing the tumour arranged in nodular pattern with peripheral palisidation. The area of blackish pigmentation s noted. (Haematoxyline & Eosin stain,100x). Discussion The most common malignant tumour of eyelid and surrounding structures are BCC 80-90%, followed by Squamous cell carcinoma – 40%, sebaceous carcinoma -5%, melanoma 1% etc.[2] The common age affected were in elderly with highest incidence among patients of 70-75 years.[6]In our case patient was 55 years of age with involvement of lower eyelid. It is reported that lower lid is most commonly affected, site middle and upper lids are very rare to get involved. Various predisposing factors for basal cell carcinoma are albinism, xeroderma pigmentation, geographic, environmental and carcinogens have been explained[7] The farmers exposed to environmental risk factors are more likely to develop BCC at a younger age. On clinical presentation our patient showed irregular, ulceroproliferative growth with everted edges. The size is larger in our case as compared to other reported cases where size is 0.2-1.5 cm. Usually clinical presentation is of small papule which later on gives nodule formation, Associated with ulcer, pigmentation were noted The definitive diagnosis is done on histopathological study. On histopathological examination our case showed diffuse, nodular, ulcerated lesion with classic palisidation of tumour and solid nodular growth pattern. Areas of melanin pigmentation was noted. The most common histological type of BCC is nodular (40-50%), other are infiltrative, (15 to 25%), ulcerative morphea like, sclerosing, mixed, basosquamous, pigmented etc.[2],[8] Rarely sebaceous differentiation was noted. The treatment modalities are usually of surgical excision, local chemotherapy, cryotherapy, immune modulatory agents.[9]The high incidence of recurrence is noted if incomplete resection, involved resected surgical margin, location of tumour near canthus, infiltrative type at growth, morphea, basosquamous subtypes, high immunoreactive of ki 67 tumours. It is stated that surgical resection is good for the curative treatment. Rarely recurrence and metastasis have been noted. BCC a slowly progressive and poorly metastasizing skin cancer with propensity to be locally destructive Nature.[10],[11] The early diagnosis and adequate treatment is essential for better prognosis. Conclusion We are presenting this case for its clinical manifestations and histopathological findings. As the clinical feature, histopathological subtypes and treatment modality determines the coarse of disease. Conflicts of Interest: None.         References ^ Cigna E, Tarallo M, Maruccia M, Sorvillo V, Pollastrini A, Scuderi N, et al. Basal cell carcinoma: 10 years of experience. J Skin Cancer 2011:4;76:36 -42. a, b, c Dourmishev LA, Rusinova D, Botev I. Clinical variants, stages, and management of basal cell carcinoma. Indian Dermatol Online J 2013; 4:12–17. ^ Asproudis I, Sotiropoulos G, Gartzios C, Raggos V, Papoudou-Bai A, Ntountas I, et al. Eyelid tumors at the university eye clinic of Ioannina, Greece: A 30-year retrospective study. Middle East Afr J Ophthalmol 2015;22:230–232 ^ Marzuka AG, Book SE. Basal cell carcinoma: Pathogenesis, epidemiology, clinical features, diagnosis, histopathology, and management. Yale J Biol Med 2015;88:167–179. ^ Totir M, Alexandrescu C, Pirvulescu R, Gradinaru S, Costache M. Clinical, histopathological and therapeutical analysis of inferior eyelid basal cell carcinomas. J Med Life 2014; 7:18–22. ^ Saleh GM, Desai P, Collin JRO, et al. Incidence of eyelid basal cell carcinoma in England: 2000–2010. Br J Ophthalmol 2017;101:209-212. ^ Dessinioti C, Antoniou C, Katsambas A, Stratigos AJ. Basal cell carcinoma: What’s new under the sun. Photochem Photobiol 2010;86:481?91. ^ Paavilainen V, Aaltonen M, Tuominen J, Saari K.M. Histological Characteristics of Basal Cell Carcinoma of the Eyelid. Ophthalmic Res 2007;39:45–48. ^ Buschmann W.: A reappraisal of cryosurgery for eyelid basal cell carcinomas. Br J Ophthalmol 2002,86: 453–457. ^ Jagtap SV, Aher VC, Jagtap S S, Khandelwal R S.Cytopathological study of lymphadenopathies in malignant lesions: an institutional study. Int J Med Health Sci 2016;5(3):154-157. ^ A. I. Rubin, E. H. Chen, and D. Ratner, “Basal-cell carcinoma,” Engl J Med 2005;353(21): 2262–2269.

Chronic Myelogenous Leukemia (CML) is a chronic myeloproliferative neoplasm characterised by uncontrolled proliferation of mature and maturating granulocytes. In our case 42 year male over a period of 13 months showed blastic transformation with severe thrombocytopenia, disseminated intravascular coagulation and bleeding. Herewith we present this case for its clinical behaviour, hematological findings and disease course. Keyword: Myeloproliferative Neoplasms, Blast crisis, Leukemia.

Amongst thyroid malignancies papillary carcinoma is the most common form. It usually remains intrathyroid and carries good prognosis. In our care, it was presented with rapid onset of clinical manifestations within 2 months duration. A 54 years old male patient had history of change in voice, enlargement of thyroid with multiple cervical lymphnodes enlargement. On fine needle aspiration cytology, ultrasonography, computed tomography scan neck diagnosed as malignant thyroid lesion. He underwent total thyroidectomy with left cervical radical neck dissection. On histopathology showed invasive papillary carcinoma with extensive nodal metastasis. Keywords: Thyroid carcinoma, Papillary carcinoma, Regional node metastasis.

Abstract Introduction Gestational Trophoblastic Disease (GTD) is a term used for a group of pregnancy-related tumours. These consist of various tumours and tumour like lesions characterized by proliferation of trophoblastic tissue. Amongst GTD, hydatidiform moles are the most common form. These lesions sometimes may develop into invasive moles, or, in rare cases, into choriocarcinoma. Aim To study the clinicopathologic characteristics and prevalence of different forms of gestational trophoblastic disease in a tertiary care hospital. Materials and Methods The present study was descriptive, observational, analytical type done in Department of Pathology at tertiary care hospital from May 2012 to April 2016. All cases clinically suspected of GTD were included and confirmation was done by histopathological study on H&E stained slides. The cases of GTD were classified according to WHO classification. Detailed histomorphological features and beta human Chorionic Gonadotropin (hCG) levels were correlated. Results During study period, 18345 deliveries were reported; out of which 77 cases were diagnosed as GTD. Almost 97.40% cases were of hydatidiform moles, 1.30% cases of choriocarcinoma and 1.30% cases of Placental Site Trophoblastic Tumour (PSTT). Among the cases of hydatidiform mole 57.34% were complete mole and 41.33% cases were of partial mole. The common clinical presentation was per vaginal bleeding and amenorrhea. The blood group A was most commonly observed in patient (49.35%). In majority of cases beta hCG levels were between 50,000 to 100000 mIU/ml. The correlation between beta hCG level and GTD were done. Conclusion Pregnant females clinically presenting with abnormal vaginal bleeding must be evaluated for GTD. Histopathological examination is helpful for confirmatory dia

Background Primary squamous cell carcinoma (SCC) is a very rare malignancy of the breast. It is a tumour of the elderly age group. Pure squamous cell carcinoma of the breast can deviate from epidermis, the nipple or the epithelium of deep-seated epidermoid cyst or squamous metaplasia on chronic inflammation background. Case report Our case is a 60-year-old female patient who presented with a lump in her left breast. Left-side modified radical mastectomy was done. It was histopathologically diagnosed as squamous cell carcinoma of the breast (SCCB). There was no axillary node involvement. After one and half years, the patient presented with breathlessness and weakness. Investigations revealed lung metastasis with pleural effusion, and postoperative chemotherapy was given. The patient has attended regular follow-ups for the last 8 months. Conclusions The prognosis of this disease is highly uncertain and the treatment options are unclear and controversial. There is inadequate literature and treatment guidelines are lacking.

Ileal neuroendocrine tumors are rare primary epithelial neoplasm arising from enterochromaffin cells. A 65-year-old male presented with complaints of recurrent abdominal pain of 1 year duration. The pain was more aggravated in last 7 days associated with vomiting, loss of appetite and diarrhea. On radioimaging ultrasonography finding impression of small bowel mass lesion suggestive of ileac carcinoid tumor with ischemic bowel disease was given. Computerized tomograph abdomen pelvis showed a well-defined hypodense, round, hetergenous, enhancing mass measuring 2.6x1.6x1.2 cm., showing arterial enhancement in mesentery in close relation to ileum and metastatic lymph node mass- indicating likeness of neuroendocrine tumor. The surgical resection of ileum with mass and enlarged mesenteric nodes were done. On gross examination ileum specimen on cut open showed multiple, irregular mucosal thickenings with foci of ulceration. The submocosa showed single, circumscribed, round tumor measuring 3 x 2.5x1.5 cm. Cut section of tumor was yellowish, tan, well circumscribed and solid. The mesenteric lymph nodes were enlarged. The microscopic examination ileum showed a tumor composed of uniform, round cells having to oval nuclei with salt and pepper chromatin. Tumor cells were arranged in trabecular, nests, ribbons and in areas pseudo glandular pattern. Increased mitotic activity was noted (4/10 high power field). Mesenteric lymph nodes were involved by tumor. On histopathology reported as Well-differentiated neuroendocrine tumors (NET), G2, intermediate grade of ileum. The immunohistochemical stain were positive for synaptophysin, chromogranin A. The Ki-67 expression was Keywords: Neuroendocrine tumors, Ileal tumors, Intestinal obstruction

Coronaviruses: CoVs, is related to the family of Coronaviridae. The SARS-CoV-2: severe acute respiratory syndrome coronavirus 2, is unique strain of RNA viruses. The recent pandemic caused by coronavirus SARS-CoV-2 is threatening the human population worldwide. The patients with severe forms may develop severe pneumonia and may fatal. The COVID-19 range from a mild to severe form., SARS-CoV-2 infected patients shows severe lymphopenia in about 2/3 cases. In patients with severe disease lymphocyte subset counts in the peripheral blood owere significantly reduced. The predictor biomarker for assessing disease and monitoring with SARS-CoV-2 infection is done by peripheral blood CD4+ and CD8+ T cells' count. It is necessary to do more studies on larger populations and detail understanding of Tell immunity and for new treatment strategies.   Keywords: Coronaviruses, COVID­19 biomarkers, CD4+ and CD8+T cells, Prognostic role T lymphocytes

The anaplastic oligodendrogliomas are uncommon gliomas. It is clinically significant to know this entity as they have unique clinical, histopathological and molecular features. We present a 43 year female having complaint of headache, tingling numbness, giddiness. Which was of 2 year duration, off and on, and was increased in last 15 days. MRI brain (plain + contrast) showed a large heterogenously enhancing cortical based solid-cystic lesion with surrounding edema in left frontal lobe with mass effects and midline shift. On radiological features impression was suggestive of high grade glial neoplasm and advised biopsy. In our case on histopathology reported as anaplastic oligodendrogliomas WHO CNS grade 3 of left frontal lobe. Patient was treated with surgery, and chemotherapy. We are presenting this rare case of anaplastic oligodendrogliomas for it’s clinical, Histopathological and radiological findings.   Keywords: Oligodendroglioma, CNS grade 3 tumors, Histopathology, Anaplastic oligodendrogliomas

Background: Male breast cancer is a very rare neoplasm which accounts for 1% of all breast cancers. In males breast tissue is much smaller than females and these cancer can easily invade the skin and pectoral muscles. Case Presentation: A 62-year old male patient with chief complaint of swelling in right breast since 6 months, the size of which had increased rapidly in last three months and associated with pain. Sonomammography reveals lobulated hypoechoic lesion in right retroareolar region. Fine nedle aspiration cytology reported as positive for carcinoma cells right breast. Right breast modifided radical mastectomy was performed. On histopathological findings reported as invasive breast carcinoma. RB score: 1+2+2=5 Grade I. The immunohistochemistry for hormone receptor showed positive estrogen receptor (ER) and progesterone receptor (PR), while HER2 was negative. All surgical margins and lymph nodes received from right axillary clearance were free from tumor. Conclusion: We are presenting this extremely rare case of male breast cancer for its clinico-pathological findings. The tumor was medium size, with no axillary lymph node metastasis and on histopathology reported as invasive breast carcinoma grade I, which favored good prognostic criteria.   Keywords: Lump in breast, Mastectomy, Male breast cancer, Invasive breast carcinoma

The clear-cell variant of gallbladder is exceedingly rare tumor. A 56 year male patient presented with complaints of pain in the right upper quadrant of abdomen with vomiting, anorexia, weight loss. On radio imaging ultrasonography, computed tomography and magnetic resonance cholangiopancreatography abdomen- pelvis reveals a 2 x 2 cm gallbladder mass. Tumor was extending in adjacent segment 5 of liver and lymph nodes. Features were in favors of carcinoma of the gall bladder with liver extension and regional lymph nodal metastasis. Patient underwent an open cholecystectomy with lymph nodes resection. On histopathological findings we reported as clear cell adenocarcinoma with Hepatoid differentiation of gallbladder. We are presenting rare case of moderately differentiated clear cell adenocarcinoma with Hepatoid differentiation of gallbladder