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Breast cancer is the most common malignancy in female patients with Li–Fraumeni syndrome (LFS), a rare autosomal dominant hereditary syndrome characterized by germline TP53 mutations. Recent studies have shown that the majority of these tumors are estrogen receptor (ER) positive with frequent HER2 co-expression. However, the morphologic features of these tumors have not been as well studied as other germline-associated breast cancers. We evaluated the pathologic features of 27 invasive and in situ carcinomas from patients with known germline TP53 mutations collected through the Li–Fraumeni Consortium. Overall, 60% of cases were HER2 positive and 44% showed ER co-expression. Most DCIS was high nuclear grade with central necrosis and associated periductal fibrosis and lymphocytic response. Invasive carcinomas were mostly of ductal type (NOS), modified Scarff–Bloom–Richardson (mSBR) high grade, with marked nuclear atypia and high mitotic rate. Prominent tumor infiltrating lymphocytes, syncytial growth pattern, or pushing borders were not seen in these tumors. High p53 IHC expression was seen in tumors from individuals with germline TP53 missense mutations whereas little or no protein expression (

Purpose: Exercise after breast cancer diagnosis is associated with lower cancer-specific mortality, but the biological mechanisms through which exercise impacts breast cancer are not fully understood. The Pre-Operative Health and Body (PreHAB) Study was a randomized window-of-opportunity trial designed to test the impact of exercise on Ki-67, gene expression, and other biomarkers in women with breast cancer. Experimental Design: Inactive women with newly diagnosed breast cancer were randomized to an exercise intervention or mind–body control group, and participated in the study between enrollment and surgery (mean 29.3 days). Tumor and serum were collected at baseline and surgery. Results: Forty-nine women were randomized (27 exercise, 22 control). At baseline, mean age was 52.6, body mass index was 30.2 kg/m2, and exercise was 49 minutes/week. Exercise participants significantly increased exercise versus controls (203 vs. 23 minutes/week, P < 0.0001). There were no differences in changes of expression of Ki-67, insulin receptor, and cleaved caspase-3 in exercise participants versus controls. KEGG pathway analysis demonstrated significant upregulation of 18 unique pathways between the baseline biopsy and surgical excision in exercise participants and none in control participants (q < 0.1). Top-ranked pathways included several implicated in immunity and inflammation. Exploratory analysis of tumor immune infiltrates demonstrated a trend toward a decrease in FOXP3+ cells in exercise versus control participants over the intervention period (P = 0.08). Conclusions: A window-of-opportunity exercise intervention did not impact proliferation but led to alterations in gene expression in breast tumors, suggesting that exercise may have a direct effect on breast cancer. See related commentary by Koelwyn and Jones, p. 5179

One of the most recent advances in the treatment of HER2+ breast cancer is the development of the antibody–drug conjugate, T-DM1. T-DM1 has proven clinical benefits for patients with advanced and/or metastatic breast cancer who have progressed on prior HER2-targeted therapies. However, T-DM1 resistance ultimately occurs and represents a major obstacle in the effective treatment of this disease. Because anti-apoptotic BCL-2 family proteins can affect the threshold for induction of apoptosis and thus limit the effectiveness of the chemotherapeutic payload, we examined whether inhibition of BCL-2/XL would enhance the efficacy of T-DM1 in five HER2-expressing patient-derived breast cancer xenograft models. Inhibition of BCL-2/XL via navitoclax/ABT-263 significantly enhanced the cytotoxicity of T-DM1 in two of three models derived from advanced and treatment-exposed metastatic breast tumors. No additive effects of combined treatment were observed in the third metastatic tumor model, which was highly sensitive to T-DM1, as well as a primary treatment-exposed tumor, which was refractory to T-DM1. A fifth model, derived from a treatment naïve primary breast tumor, was sensitive to T-DM1 but markedly benefited from combination treatment. Notably, both PDXs that were highly responsive to the combination therapy expressed low HER2 protein levels and lacked ERBB2 amplification, suggesting that BCL-2/XL inhibition can enhance sensitivity of tumors with low HER2 expression. Toxicities associated with combined treatments were significantly ameliorated with intermittent ABT-263 dosing. Taken together, these studies provide evidence that T-DM1 cytotoxicity could be significantly enhanced via BCL-2/XL blockade and support clinical investigation of this combination beyond ERBB2-amplified and/or HER2-overexpressed tumors.

Background Targeted therapies for triple-negative breast cancer (TNBC) are limited; however, the epidermal growth factor receptor (EGFR) represents a potential target, as the majority of TNBC express EGFR. The purpose of these studies was to evaluate the effectiveness of two EGFR-targeted antibody-drug conjugates (ADC: ABT-414; ABBV-321) in combination with navitoclax, an antagonist of the anti-apoptotic BCL-2 and BCL-XL proteins, in order to assess the translational relevance of these combinations for TNBC. Methods The pre-clinical efficacy of combined treatments was evaluated in multiple patient-derived xenograft (PDX) models of TNBC. Microscopy-based dynamic BH3 profiling (DBP) was used to assess mitochondrial apoptotic signaling induced by navitoclax and/or ADC treatments, and the expression of EGFR and BCL-2/XL was analyzed in 46 triple-negative patient tumors. Results Treatment with navitoclax plus ABT-414 caused a significant reduction in tumor growth in five of seven PDXs and significant tumor regression in the highest EGFR-expressing PDX. Navitoclax plus ABBV-321, an EGFR-targeted ADC that displays more effective wild-type EGFR-targeting, elicited more significant tumor growth inhibition and regressions in the two highest EGFR-expressing models evaluated. The level of mitochondrial apoptotic signaling induced by single or combined drug treatments, as measured by DBP, correlated with the treatment responses observed in vivo. Lastly, the majority of triple-negative patient tumors were found to express EGFR and co-express BCL-XL and/or BCL-2. Conclusions The dramatic tumor regressions achieved using combined agents in pre-clinical TNBC models underscore the abilities of BCL-2/XL antagonists to enhance the effectiveness of EGFR-targeted ADCs and highlight the clinical potential for usage of such targeted ADCs to alleviate toxicities associated with combinations of BCL-2/XL inhibitors and systemic chemotherapies.

Objective: To find out the situation and causes of anaemia in pregnant women at MMIMSR during the study period with special reference to the severity of the disease and to find out foetal outcome in pregnant women with anaemia. Methods: The study was conducted in Department of Obstetrics and Gynaecology, MMIMSR, Mullana, Ambala(India). The study was carried out between the period of october 2012 to September 2014.A total of 200 cases of moderate and severe anaemia were included in the study on the basis of simple random sampling method and 200 cases of non anaemic subjects were included to serve as controls for the anaemic group, during the study period. Hb gm/dl was taken as criteria for deciding anaemia cases and also to classify them according to the severity. Cases were classified according to WHO criteria. Results: Out of 200 cases of anaemia, 70% were moderately anaemic (Hb 7 – 9.9gm/dl) and 30% were severly anaemic (Hb < 7gm/dl). Microcytic hypochromic type of anaemia (82.5%) was more prevalent suggesting nutritional inadequacies as cause of anaemia. Adverse foetal outcome in the form of preterm birth (17%), still birth (3.5%), low birth weight babies (27.5%), neonatal morbidity (23.3%) was more in the anaemic group than non anaemic controls Conclusion: Anaemia in pregnancy has adverse foetal outcome in the form of decreased birth weight, increased perinatal morbidity and mortality. Bangladesh Journal of Medical Science Vol.18(1) 2019 p.63-72

Background: Anaemia in pregnancy is one of the most important and common public health problem not only in India but also in most of the South East Asian countries. Anaemia is the most common nutritional deficiency disorder in the world. There is predominance of iron deficiency anaemia (nutritional anaemia). In pregnancy, it is one of the leading causes responsible for maternal and perinatal morbidity and mortality.Objective: To find out the risk factors associated with anaemia in pregnant women at MMIMSR during the study period with special reference to the severity of the disease.Methods: The study was conducted in Department of Obstetrics and Gynaecology, MMIMSR, Mullana, Ambala. The study was carried out between the period of october 2012 to September 2014.A total of 200 cases of moderate and severe anaemia were included in the study on the basis of simple random sampling method and 200 cases of non anaemic subjects were included to serve as controls for the anaemic group, during the study period. Hb gm/dl was taken as criteria for deciding anaemia cases and also to classify them according to the severity. Cases were classified according to WHO criteria.Results: Out of 200 cases of anaemia, 70% were moderately anaemic (Hb 7 – 9.9gm/dl) and 30% were severly anaemic (Hb < 7gm/dl). Microcytic hypochromic type of anaemia (82.5%) was more prevalent suggesting nutritional inadequacies as cause of anaemia.Conclusion: In the present study maternal illiteracy, low SES, inadequate antenatal care, close birth spacing, poor nutrition were all risk factors for anaemia in pregnancy Microcytic hypochromic type of anaemia (82.5%) was more prevalent suggesting nutritional inadequacies as cause of anaemia.Bangladesh Journal of Medical Science Vol.17(4) 2018 p.583-592

Background: Anaemia in pregnancy is one of the most important and common public health problem not only in India but also in most of the South East Asian countries. Anaemia is the most common nutritional deficiency disorder in the world. There is predominance of iron deficiency anaemia (nutritional anaemia). In pregnancy, it is one of the leading causes responsible for maternal morbidity and mortality.Objective: To find out the maternal outcome in pregnant women with anaemia at MMIMSR during the study period with special reference to the severity of the disease.Methods: The study was conducted in Department of Obstetrics and Gynaecology, MMIMSR, Mullana, Ambala(India). The study was carried out between the period of october 2012 to September 2014.A total of 200 cases of moderate and severe anaemia were included in the study on the basis of simple random sampling method and 200 cases of non anaemic subjects were included to serve as controls for the anaemic group, during the study period. Hb gm/dl was taken as criteria for deciding anaemia cases and also to classify them according to the severity. Cases were classified according to WHO criteria.Results: Out of 200 cases of anaemia, 70% were moderately anaemic (Hb 7 – 9.9gm/dl) and 30% were severly anaemic (Hb < 7gm/dl). Microcytic hypochromic type of anaemia (82.5%) was more prevalent suggesting nutritional inadequacies as cause of anaemia. Higher incidence of preterm (17%), PPH (7.5%), maternal morbidity (14.5%) was found in anaemic group as compared to non anaemic controls.Conclusion: Anaemia in pregnancy has adverse maternal outcome in the form of maternal morbidity, preterm labour, and increased incidence of operative delivery.Bangladesh Journal of Medical Science Vol.17(3) 2018 p.446-454

Background Immunohistochemical (IHC) evaluation has shown that human epidermal growth factor receptor 2 (HER2) may not be expressed homogeneously among all cancer cells within a given tumor. The clinical significance of intratumoral HER2 heterogeneity is unclear. Exploration of tumor heterogeneity is facilitated by tissue imaging technologies such as t-CyCIF, a highly multiplexed immunofluorescence microscopy technique that permits visualization of up to 60 antigens and analysis on a single cell level from formalin-fixed, paraffin-embedded tissue. To utilize t-CyCIF for the evaluation of breast tumors, this study was undertaken to: 1) validate antibodies to be used against the clinically relevant markers HER2, estrogen receptor (ER) and progesterone receptor (PR), and 2) use these antibodies along with other validated antibodies to define the tumor microenvironment (TME) to interrogate breast tumors at a single cell level. Methods T-CyCIF is an iterative whole-slide imaging process, in which successive four-channel images, each involving different antibodies, are collected from the same sample and then merged to generate a high-dimensional representation used for visualization and analysis. In phase one of this study, 948 tissue cores (representing 295 patients in triplicate) were used to validate HER2, ER, and PR antibodies against a single antibody commonly used in clinical practice as a reference. Analyses were performed at the level of tissue cores, cells and pixels. Inter-assay analyses were performed comparing: t-CyCIF vs. IHC, the latter assessed by digital pathology and two pathologists; and also, t-CyCIF vs. fluorescence in situ hybridization (FISH) for HER2. In the second phase, following selection of validated HER2, ER and PR antibodies, expression of CD45, CD68, PD-L1, p53, Ki67, pRB and the androgen receptor (AR) were evaluated at a single cell level in 312 HER2+ invasive breast cancer samples, representing 104 patients, to better understand the TME, cancer cell heterogeneity and the cell identities/states present in breast carcinomas. Results In the first phase of the study, 13 different ER, PR or HER2 antibodies were analyzed. The pixel-to-pixel evaluation, which evaluates concordance in staining, resulted in r scores of 0.86 (ER; Pearson correlation), 0.93 (PR) and 0.94 (HER2) and correlation scores in single-cell comparisons ranged from 0.76 to 0.81. Correlation scores on the tissue core level were high in the inter-assay analyses, i.e. t-CyCIF vs. IHC (e.g. r scores up to 0.87 and 0.91 for ER and HER2, respectively, on t-CyCIF vs. Aperio; and 0.85 to 0.94 by pathology review) and t-CyCIF vs. HER2 FISH (r scores up to 0.71). This resulted in validated fluorophore-conjugated antibody panels for use in t-CyCIF that correspond well to established standards. In the second phase, single cell analysis of HER2+ breast cancer was performed. Cancer cells were defined as keratin positive and using t-Distributed Stochastic Neighbor Embedding (t-SNE) seven cancer cell clusters were identified including two HER2hi clusters differing in ER, p53, AR and PD-L1 expression, two HER2lo clusters differing in PR, Ki67, pRB, p53 and AR and three HER2neg clusters differing in PR, Ki67, ER, PD-L1 and AR. Heterogeneity scores were calculated based on diversity among clusters. Conclusion This study is the first to evaluate the performance of breast cancer-specific antibodies in a highly multiplexed imaging platform such as t-CyCIF. Using the validated antibody panel, we uncovered patterns of expression of markers relevant to breast cancer biology that correlate with HER2 high, low and negative states. Ongoing studies are looking at correlations between HER2 heterogeneity, responses to therapy and clinical outcomes. Citation Format: Jennifer L Guerriero, Jia-Ren Lin, Ricardo G Pastorello, Ziming Du, Shaolin Mei, Krishan Taneja, Stuart J Schnitt, Deborah A Dillon, Peter K Sorger, Sandro Santagata, Elizabeth A Mittendorf. Highly multiplexed tissue-based cyclic immunofluorescence (t-CyCIF) for precision oncology identifies novel patterns of HER2 heterogeneity in breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS18-02.

Background: Tissue-based cyclic immunofluorescence (t-CyCIF) is a recently described technique for highly multiplexed immunofluorescence microscopy of formalin-fixed, paraffin-embedded (FFPE) specimens. Via an iterative process, successive four-channel images are collected from the same sample and then registered to each other to generate a high-dimensional representation that is used for visualization and analysis. This technique can be used to capture up to 60 different antigens on a single FFPE tumor section and permits quantification of cell lineage and state markers, intracellular signaling proteins, drug targets and immune cell antigens, thereby promoting biomarker discovery efforts that are fundamental to precision oncology. As with most technologies that utilize immunostaining, proper antibody validation is key to reliable performance. In this study we used t-CyCIF to evaluate multiple antibodies directed against proteins commonly used to characterize breast carcinomas and their associated microenvironment. Our goal was to validate these antibodies on the t-CyCIF platform prior to the more widespread use of this technology to propel novel discoveries on breast cancer initiation, progression and treatment. Methods: To choose the optimal antibody candidate for each biomarker in t-CyCIF, we compared multiple fluorophore-conjugated antibodies for each of the following three proteins routinely evaluated in breast carcinomas: estrogen receptor (ER), progesterone receptor (PR) and HER2. For each of these, a single antibody commonly used in clinical practice was used as a reference. Analyses were performed at the level of pixels, cells and tissue cores. In addition, inter-assay analyses were performed comparing: (1) t-CyCIF vs. immunohistochemistry (IHC), the latter assessed both by digital pathology and by two independent pathologists; and (2) t-CyCIF vs. fluorescence in situ hybridization (FISH) for HER2. Following validation of these antibodies, we evaluated the expression of CD45, CD68, PD-L1, p53, Ki67 and androgen receptor along with ER, PR and HER2, to better understand both the tumor microenvironment and the cell identities/states in breast carcinomas. Results: A total of 948 tissue cores were included in the study. In the first phase, 13 different antibodies were analyzed: three raised against ER and five each against PR and HER2. The pixel-to-pixel evaluation resulted in r scores using Pearson correlation equal to 0.86 for both ER markers tested; ranging from 0.88 to 0.93 for PR; and from 0.56 to 0.94 for HER2. The correlation scores in single-cell comparisons ranged from 0.76 to 0.88 for ER, 0.54 to 0.81 for PR, and from 0.56 to 0.76 for HER2. Comparisons were then performed at the tissue core level. In light of the data generated through these multiple levels of analyses, we identified fluorophore-conjugated candidates for use in t-CyCIF. Correlation scores on the tissue core level were high in the inter-assay analyses, i.e. t-CyCIF vs. IHC (e.g. r scores up to 0.91 for HER2 on t-CyCIF vs. IHC) and t-CyCIF vs. HER2 FISH (r scores up to 0.71). In the second phase, we characterized the tumor microenvironment and cell identities present in 260 breast carcinomas. With a qualified panel of antibodies, we performed single-cell analyses of 589,343 cells and identified unexpected patterns of PD-L1 expression in distinct populations of tumor cells. Conclusion: This study is the first to evaluate the performance of breast cancer-specific antibodies in a highly multiplexed imaging platform such as t-CyCIF. This work demonstrates a step-by-step approach for qualifying reagents to be used in a multiplexed, spatially resolved tissue imaging modality. This validation study will facilitate the use of t-CyCIF for additional studies in breast cancer to evaluate both tumor elements and components of the microenvironment. Citation Format: Ricardo G Pastorello, Jia-Ren Lin, Ziming Du, Shaolin Mei, Krishan Taneja, Deborah A Dillon, Stuart J Schnitt, Peter K Sorger, Elizabeth A Mittendorf, Sandro Santagata, Jennifer L Guerriero. Highly multiplexed tissue-based cyclic immunofluorescence in breast cancer for precision oncology [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-02-03.

Background: The objective of the study was to evaluate the safety and efficacy of immediate postpartum intrauterine contraceptive device (PPIUCD) insertion in women delivering vaginally or by cesarean section. Methods: This prospective study was carried out at General Hospital [Tertiary care] from August 2014 to September 2015. All antenatal patients admitted for delivery to our hospital were counseled for PPIUCD. Also consent was taken from those who opted for PPIUCD insertion. Results: A total of 2016 women were counseled for PPIUCD adoption. Out of this, 1312 women accepted this method. Total number of deliveries during the study period was 2835. Total acceptance rate was 46.27%. The expulsion rate was 10.63% while removal rate was 7.74%. Out of 555 women who came for follow up, 453 women continued PPIUCD. Thus, continuation rate was 81.62%. Conclusions: PPIUCD is easily accessible, reversible and cost effective contraceptive method for most postpartum women specially lactating women.

Background: The objective of the study was to correlate hysteroscopic findings with histopathological findings in women with abnormal uterine bleeding and to study the accuracy of hysteroscopy in abnormal uterine bleeding. Methods: Settings: tertiary care hospital. Study design: prospective study. A prospective study was carried out in the Department of Obstetrics and Gynaecology at MMIMSR, Mullana, Ambala, from May 2011 to September 2013. 100 cases were selected for this study from patients who were admitted with history of abnormal uterine bleeding. Hysteroscopic examination was done in all patients post-menstrually, whenever possible, except in those cases where menstrual cycles were grossly irregular or patients came with continuous bleeding per vaginum. The patients then underwent dilatation and curettage and curettings was sent for histopathological examination. The correlation between findings on hysteroscopy and histopathological examination was done. Results: On hysteroscopy, 48% of the patients had either proliferative or secretory picture which was grouped as normal. The rest 52% of patients had some abnormality. Hyperplasia was the most common finding which was seen in 26% patients. The other findings included endometrial polyp 8%, myoma or myomatous polyp 7%, atrophic endometrium 4%, endometrial carcinoma, misplaced IUCD, and synechiae comprising 2% each and tubercular endometritis 1%. Conclusions: Hysteroscopy has a high sensitivity i.e. it can supplement and enhance the accuracy of tissue diagnosis. So, hysteroscopically directed biopsy would be an ideal procedure in abnormal uterine bleeding wherever facilities are available.

A broad ligament pregnancy is an extremely rare condition. Diagnosis is often missed and finally made during laparotomy. We present a case which remained undiagnosed throughout her pregnancy till she reached term and unfortunately had intrauterine foetal demise when she reported to our hospital. On clinical suspicion, ultrasound and magnetic resonance imaging evaluation was done which picked up the diagnosis of abdominal pregnancy. On laparotomy a broad ligament pregnancy was found with a rent in the previous Cesarean scar towards the gestational sac in the broad ligament.

To compare the efficacy of different intervals of misoprostol administration (simultaneously vis-a-vis 24 h), after mifepristone, in women undergoing medical termination of pregnancy up to gestation of 49 days. Eighty eligible women with single intrauterine pregnancy of ≤7 weeks of gestation requesting abortion were randomized to receive either 200 mg of mifepristone orally and 400 μg of misoprostol vaginally simultaneously (Group 1) or at 24-h interval (Group 2).Women who had no bleeding after the drugs were offered a second dose of misoprostol 24 h after the first dose. All patients were followed up on day 14. Primary outcome measure was the complete abortion rate. Secondary outcome measures were the induction–abortion interval, adverse effects, especially bleeding, and treatment acceptability rate. Treatment was considered a failure if surgical intervention was needed for any indication. Complete abortion was achieved in 38 women [95%; 95% confidence interval (CI) 88%, 100%] in Group 1 and 39 women (97.50%; 95% CI 93%,100%) in Group 2 (p = 0.56). A second dose of misoprostol was needed in two patients in Group 1 and in only one patient in Group 2. The induction–abortion interval was 6.50 ± 1.48 h in Group 1 and 5.95 ± 1.81 h in Group 2 (p = 0.13). The difference in frequency of adverse effects in the two groups was statistically insignificant (p = 0.18). The treatment acceptability rate was 97.50% in Group 1 and 95% in Group 2 (p = 0.56). Simultaneous administration of mifepristone and 400 μg vaginal misoprostol is an effective alternative to standard regimens for medical abortion up to 49 days of gestation.

A broad ligament pregnancy is an extremely rare condition. The eventuality of such pregnancies reaching full term is even rarer. A full-term broad ligament pregnancy occurring through a rent in a previous lower segment caesarean scar has only been mentioned in literature but not reported. Our patient is an unbooked case, reported to us at 39 weeks of pregnancy. On clinical examination, an ultrasound and an MRI, a diagnosis of abdominal pregnancy was made. Ultimately the final diagnosis was made only on laparotomy. A broad ligament pregnancy was found with a rent in the previous caesarean scar communicating the fetal sac.

Pyometrocolpos resulting from congenital obstructing lesions can present during early childhood and adolescence with varying signs and symptoms. Children with pyometrocolpos due to distal vaginal obstruction may present as acutely ill with obstructive uropathy and septicaemia. We present a case of a two year old girl with pyometrocolpos in whom drainage under anaesthesia lead to marked improvement of her clinical symptoms. Hydrometrocolpos is a condition in which the uterus and vagina are distended by retained fl other than blood in the presence of distal vaginal outlet obstruction. Secondary infection of hydro- metrocolpos leads to pyometrocolpos (pyometra). The condition is rarely diagnosed in the neonate or infant until the obstruction causes a significant fluid collection in the vagina above the ob- structing septum and cause compression effect to the surrounding structures. Diagnosis is made initially by abdominal ultrasonogra- phy but magnetic resonance imaging (MRI) is used for defi nitive diagnosis. It can be diagnosed prenatally, during the third trimes- ter by transabdominal sonography (1). In children the hydrometro- colpos present usually as suprapubic cystic mass with or without retention of urine which may be an acute emergency (2). Urgent drainage of the infected cystic mass leads to marked improvement in the clinical course of such patients who require defi nitive sur- gery at a later stage (3). Rarity and variable presentations can lead to delayed diagnosis and erroneous management.

Hydatidosis is a common zoonosis that affects a large number of humans and animals, especially in poorly developed countries. Mesenteric hydatid cysts are rare intra abdominal lesions with variable clinical symptoms and signs that make preoperative diagnosis diffi cult. The treatment is surgical excision followed by mebendazole for four months. We report this unusual case where preoperative diagnosis of right tubo-ovarian mass was made and the diagnosis of mesenteric hydatid cyst could be made only on laprotomy and microscopic examination after surgery.