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Primary thyroid lymphoma (PTL) is a rare malignancy and represents 2%-5% of all thyroid malignancies and 1%-2.5% of all malignant lymphomas. We present our institute's experience in combined modality management of 16 successive patients of PTL treated from2005 to 2010. The median age of the patients was 56.0 years. Five patients were males, and 11 patients were females. An enlarging thyroid mass was the most common presenting symptom. 14 patients had diffuse large B-cell lymphoma, and 2 patients had follicular lymphoma. The most common stage of presentation was stage II comprising 6 (37.5%) patients. All patients received CCT, and only 12 patients received involved field RT with a median dose of 36.0 Gy. 10 patients (62.5%) had CR, and 6 patients (27.5%) had PR. Eight patients had disease progression in subsequent followup and this included the initial 6 patients with PR. The 5-year DFS was 40.0%, and median DFS was 47 months. The 5-year OS was 41.0%, and median OS was 51 months. Most common presentation in our series was locally advanced tumors. Most of these patients require combined modality management. Risk-adapted and multimodality approach is the need of the hour to achieve good control rates while minimizing treatment related toxicity. [ABSTRACT FROM AUTHOR]

The outcome of hepatitis C virus (HCV) infection is determined by the interplay between the virus and the host immune response. Interleukin (IL)-18, an interferon-γ-inducing factor, plays a critical role in the T helper type 1 (Th1) response required for host defence against viruses, and antibodies to IL-18 have been found to prevent liver damage in a murine model. The present study was conducted to investigate the possible role of IL-18 in the pathogenesis and persistence of HCV. IL-18 levels were measured in sera of 50 patients at various stages of HCV infection (resolved, chronic and cirrhosis) and compared with those of normal controls. IL-18 gene expression was studied in peripheral blood mononuclear cells (PBMC) from each group, and in liver biopsy tissue from patients with chronic hepatitis C. The mean levels of IL-18 in sera were markedly elevated in patients with chronic hepatitis and cirrhosis, and were reduced in patients with resolved HCV infection. The serum IL-18 concentrations were related to the Child–Pugh severity of liver disease in cirrhotic patients. There also existed a strong positive correlation of IL-18 levels with histological activity score and necrosis. IL-18 mRNA expression was significantly up-regulated in the PBMC of cirrhotic patients when compared with other groups, while in the liver, higher levels of IL-18 transcripts were expressed in patients with chronic hepatitis C. The results of our study indicate that IL-18 levels reflect the severity and activity of HCV infection, and may contribute to the pathogenesis and progression of liver disease associated with HCV. [ABSTRACT FROM AUTHOR]

Background: Hepatitis C virus (HCV) has been reported to be associated with the occurrence of autoimmune disorders, including immune thrombocytopenic purpura (ITP). This has suggested that HCV could be responsible for thrombocytopenia in these patients. This study was performed to estimate the frequency of HCV infection in patients of chronic ITP (cITP), and to find the frequency of thrombocytopenia in chronic HCV infection. Materials: A total of 150 subjects were included in the study. Fifty consecutive adult patients with cITP (< 6 months'' duration) and 50 age-matched patients with chronic HCV were included for comparison of platelet counts in two groups. Fifty age-matched healthy subjects were also included in the control group. All patients'' sera were tested for the presence or absence of HCV-RNA. Anti-HCV antibodies were tested in patients as well as in controls. Complete blood count and examination of peripheral blood smear were done followed by bone-marrow aspiration to confirm the diagnosis of ITP. Results: Three patients (6%) were tested positive for anti-HCV antibodies while no subject was positive in control group (P=0.24). The prevalence of severe thrombocytopenia (platelet counts <50,000/mL) was significantly higher in ITP patients compared with that in chronic HCV patients (P=0.0001). Thrombocytopenia occurred more frequently in patient with moderate to severe than mild stage of fibrosis (P=0.001). Conclusion: In conclusion, thrombocytopenia in ITP patients was not associated with HCV infection. The prevalence of thrombocytopenia was more common and more severe in ITP patients when compared with that in patients with chronic HCV. Thrombocytopenia in chronic HCV patients was related to the stage of fibrosis and to the duration of HCV infection. [ABSTRACT FROM AUTHOR]

Purpose: Data on genotypes, basal core promoter (BCP) and precore mutants of hepatitis B virus and their association with different HBV related liver disease have been studied inadequately and are controversial. Thus, the aim of this study was to determine the incidence of BCP and precore HBV mutants and their relationship with HBV genotype and different stages of HBV related liver disease in North Indian patients.Methods: A total 273 patients with different stages of HBV related liver diseases were enrolled. Nested polymerase chain reaction (PCR) was used to amplify the BCP/PC regions. RFLP and direct sequencing were performed to validate the mutations identified in these regions. HBV genotyping was accomplished by multiplex PCR.Results: Genotype D was the predominant genotype found in each of the various HBV related liver diseases. The BCP mutation was found significantly more often in inactive carriers and compensated cirrhosis as compared to the other groups. The BCP mutation was present in 29.1% of patients with genotype D versus 17.1% with genotype A (P = 0.001). The precore mutation was also more frequently observed with genotype D compared with genotype A (36.9 vs. 4.8%, P = 0.0007).Conclusion: Genotype D is predominant in North Indian patients. The BCP and precore mutations occur in one-third of HBV positive patients in association with the genotype D. We did not find any correlation with severity of liver disease with genotypes and mutations. [ABSTRACT FROM AUTHOR]

Myocarditis is a common cardiac disease that is identified on routine postmortem examinations. Initially, coxsackie viruses, other enteroviruses and adenoviruses were thought to be more common causes of myocarditis; however, recently, parvovirus B19 (PVB19) as well as human herpesvirus 6 (HHV6) have entered the arena. We describe autopsy findings of a patient who had a lethal myocarditis with haemophagocytic lympho-histiocytosis in a course of systemic PVB19 infection. The present case illustrates the unusually severe and rapid course of PVB19 myocarditis with associated haemophagocytic lympho-histiocytosis leading to death. [ABSTRACT FROM AUTHOR]

Hepatitis C virus (HCV) infection has been associated with insulin resistance or diabetes mellitus, but data are controversial on the role of different HCV genotypes in causing insulin resistance. We have designed a study aimed at determining insulin resistance in patients with chronic hepatitis C with predominant genotype 3. Insulin resistance was measured using a homeostasis model of assessment for insulin resistance in 85 non-diabetic, non-cirrhotic patients with chronic hepatitis C (genotype 3 = 54). The results were compared with 38 biopsy-proven patients with non-alcoholic fatty liver disease and 25 age- and body mass index-matched healthy volunteers. Patients with chronic hepatitis C had a higher fasting insulin and homeostasis model of assessment for insulin resistance values than healthy volunteers (P = 0.0001). A large number of patients with chronic hepatitis C showed evidence of insulin resistance than healthy controls [53 (62.3%) vs. 4 (16%), respectively] (P < 0.0001). Of the various risk factors studied for insulin resistance in patients with chronic hepatitis C, higher waist (P = 0.010) and higher serum triglycerides (P = 0.002) were found to correlate with HOMA-insulin resistance. There was no difference in insulin resistance amongst patients with genotype 1 or 3, respectively. Based on these results, we conclude that insulin resistance is common among non-diabetic, non-cirrhotic patients with chronic hepatitis C. A majority of these patients had genotype 3, but there was no difference in insulin resistance between genotype 1 and genotype 3 patients. [ABSTRACT FROM AUTHOR]

Laryngeal osteosarcoma is an extremely rare and aggressive malignancy. Only very few cases of primary laryngeal osteosarcomas are reported in literature, and all have a dismal prognosis. A 50-year-old male presented with recurrent hoarseness of voice and was evaluated and diagnosed as sarcoma larynx. Detailed histopathology report of laryngectomy specimen revealed presence of osteoid, which confirmed the diagnosis of osteosarcoma larynx. He was further treated with adjuvant chemotherapy and radiation and is disease free after 9 months. Surgery remains the mainstay of treatment in this disease and role of adjuvant chemotherapy and radiotherapy is still evolving. [ABSTRACT FROM AUTHOR]

Rosai Dorfman disease or sinus histiocytosis is a rare, idiopathic, benign and self-limiting histiocytic proliferative disorder, usually seen in younger patients. It most commonly involves the cervical lymph nodes, with a predominant infiltration of sinusoidal histiocytes and classically presents with massive cervical lymhadenopathy. Extranodal disease occurs in about 43% of cases and produces different signs and symptoms depending upon its location. We report a case of this disorder in 22-year-old male with initial isolated involvement of bilateral nasal cavity and paranasal sinuses with subsequent involvement of cervical lymph nodes and skin. The clinical presentation, histologic characteristics, radiographic findings and treatment of the disease are discussed. [ABSTRACT FROM AUTHOR]

Breast carcinoma with micropapillary architecture is associated with aggressive behavior. Similar micropapillary pattern in pure mucinous carcinoma has been noticed and has been shown to convey poor prognosis. In this study 17 cases of pure mucinous carcinoma of the breast seen during a 10-year period have been reviewed, with special reference to micropapillary pattern. Diffuse micropapillary pattern was seen in 6 of 17 cases of mucinous carcinoma of the breast and demonstrated reverse polarity immunostaining pattern with "Epithelial Membrane Antigen." In all cases, the tumor cells showed grade I morphology, and no lymph node metastases were noticed. All the tumors except 1 expressed strong estrogen and progesterone receptor expression, however, all the cases were negative for Her-2/neu expression. In this present study, mucinous carcinomas with micropapillary pattern showed a low nuclear grade, higher incidence of hormone receptor positivity, and lower incidence of Her-2/neu similar to mucinous carcinomas without micropapillary pattern, thus explaining their indolent behavior. [ABSTRACT FROM AUTHOR]

The article describes the case of a 54-year-old man who have urinary tract infection and acute renal failure. He complained of fever and reduced urinary output and altered sensorium. The man developed a sudden onset of lower limb flaccid paralysis 3 days after the second epidural injection of depomedrol for prolapsed intervertebral disk (PIVD). The results of his imaging studies are given including USG abdomen. Treatments given to the patient include intravenous (IV) antibiotics along with central venous pressure (CVP)-guided fluids.

Background: Renal-Hepatic-Pancreatic dysplasia syndrome described by Ivemark in 1959 constitutes a triad pancreatic fibrosis, renal dysplasia and hepatic dysgenesis. Case presentation: We describe two unrelated cases of Renal-Hepatic-Pancreatic dysplasia syndrome in stillborn babies. The characteristic microscopic features were present in both the cases. The second case illustrates the unique association lymphangiectasia with Renal-Hepatic-Pancreatic dysplasia syndrome. Both cases are unrelated and there is no history of any consanguineous marriage. Conclusion: These two cases are unrelated and are rare. In the developmental research, the perinatal autopsy needs to be utilized as a major tool and an Ad hoc committee formation is required to formulate the approach towards syndromic diseases. [ABSTRACT FROM AUTHOR]

The article describes the case of a 42-year-old patient with ulnar nerve tuberculoma masquerading as a neurofibroma. Topics discussed include the results of the patient's neurological examination, which include loss of pain, touch, temperature and vibration sensation, and the excision of the mass under general anesthesia. Also mentioned is the histopathological examination which showed a well-encapsulated lesion with peripherally compressed nerve fibers.

The article describes the case of multiple endocrine neoplasia type I (MEN-I) presenting as recurrent stroke like episodes. MEN-I is not a common disease affecting 1 in 30,000 individuals worldwide. The two forms of MEN-I are sporadic and familial. Sporadic forms present with two of the three principal MEN-I related endocrine tumors, that is, pituitary, pancreatic and/or parathyroid.

Primary adenoid cystic carcinoma of lung is an unusual thoracic neoplasm, which is considered as a slow-growing low-grade malignancy. The primary treatment for this tumor is surgery. The role of radiotherapy, chemotherapy, and targeted agents is less well defined. Here we report a case of inoperable adenoid cystic carcinoma of the lung in a 42-year-old male, presenting with an unusual aggressive behavior. The patient received radiotherapy and oral tyrosine kinase inhibitor imatinib with effective palliation. [ABSTRACT FROM AUTHOR]

Choroid plexus papillomas (CPP) are most commonly found in children and rarely in adult. A very few cases are reported in geriatric population. We present a case of 72-year-old man with posterior fossa lesion operated with provisional diagnosis of metastasis, but turn out to be CPP. [ABSTRACT FROM AUTHOR]

Introduction: Rhabdomyosarcoma arising in the inguinal region has high potential of metastasis. The common sites for spread from inguinal region include regional lymph nodes, lungs, bone marrow and bone cortex. Orbit is an uncommon site for such metastasis. This case report describes a patient with inguinal rhabdomyosarcoma, which metastasized to both orbits to all the extraocular muscles. Case Report: A 14-year-old male patient presented with inguinal mass involving the scrotum. The patient underwent high inguinal orchiectomy with hemiscrotectomy for the mass and histopathology revealed rhabdomyosarcoma. After 2 weeks of initial surgery the patient developed bilateral axial proptosis and radiological imaging revealed bilateral extraocular muscle thickening involving all the extraocular muscles. A biopsy of right superior rectus muscle confirmed rhabdomyosarcoma. Comment: Although rhabdomyosarcoma is the commonest primary orbital malignant mass developing in young patients, it is an uncommon metastasis. Metastasis from inguinal rhabdomyosarcoma to extraocular muscles bilaterally involving all the muscles has not been reported in the literature. The present report describes one such patient with favorable initial response to chemotherapy and muscle thickness reverting to normal. Metastasis from a distant site should be considered in differential diagnosis when evaluating a patient with bilateral enlargement of all extraocular muscles. [ABSTRACT FROM AUTHOR]

First described as a pleural neoplasm, the solitary fibrous tumor (fibrous mesothelioma) has been reported in a number of extrapulmonary sites, including the Head-Neck region. In the Head-Neck region, it has been described in the sinonasal tract, epiglottis, parapharyngeal, retropharyngeal spaces, parotid and infratemporal fossa. We present the second case of solitary fibrous tumor of infratemporal fossa described in world literature. A complete excision was achieved by transmaxillary approach. [ABSTRACT FROM AUTHOR]

Amniotic fluid embolism (AFE) syndrome, a catastrophic cause of respiratory failure typically occurs during labour, or soon after delivery. Systemic hypotension is the most prominent haemodynamic alteration documented in patients with AFE, a consequence principally of severe left-sided heart failure. A 22-year-old female was admitted to the respiratory intensive care unit with severe eclampsia and acute respiratory failure 4 h following delivery. Her blood pressure was elevated (systolic 150–180 mm Hg, diastolic 90–110 mm Hg) throughout the admission. She succumbed in spite of therapy for eclampsia and mechanical ventilation. Autopsy revealed large numbers of polygonal, anucleate foetal squames and mucin in the pulmonary vasculature typical of AFE while changes of eclampsia were found in the liver and kidneys. It appears that AFE syndrome can have a delayed presentation, as late as 4 h after delivery and haemodynamic collapse may not be mandatory if the patient has coexisting systemic hypertension secondary to severe eclampsia. [ABSTRACT FROM AUTHOR]

Renal inflammatory malignant fibrous histiocytoma (MFH) is an extremely rare lesion and is a great masquerader of common benign renal inflammatory lesions, especially xanthogranulomatous pyelonephritis (XGPN). The clinical presentation of mass with fever and peripheral leucocytosis (marked at times), and marked inflammatory, predominantly neutrophilic, infiltrate obscuring the malignant cells on histopathology, can lead to delay in the diagnosis of this poor prognostic malignant tumor. We present the case of a patient who underwent radical nephrectomy with a clinical diagnosis of renal malignancy, but histopathology showing XGPN. The patient showed an initial clinical response, only to recur two times, ultimately leading to a histological and immunohistochemical diagnosis of inflammatory MFH. The diagnosis, histology, therapeutic options and prognosis of this rare lesion are discussed. [ABSTRACT FROM AUTHOR]

B Introduction: b Management of Gall Bladder Cancer (GBC) remains a therapeutic challenge despite recent advancement in understanding of tumor biology. IHC staining was performed to evaluate HER2NEU and EGFR status over the resected surgical specimen and image guided FNAC specimens in metastatic diseases respectively. However considering the small sample size of the study, we recommend higher level of evidence to evaluate the significance of HER2NEU and EGFR in GBC. [Extracted from the article]

B Introduction: b The spectrum of lymph nodal involvement following extended cholecystectomy and its correlation with pT Stage in carcinoma gall bladder patients is an area with less reported inspite of its pivotal role in staging and prognosis. Lymph nodal involvement in order of frequency was peripancreatic (n=9/49;18.4%),common hepatic artery(n=7/49;14.3%), periportal(n=7/49;14.3%), hepato-duodenal(n=5/49;10.2%), pericholedochal (n=4/49;8.2%), cystic (n=3/49;6.1%),coeliac (n=2/49;4.1%), LHA nodes(1/49;2%) and RHA lymph nodes (1/49;2%). Lymph nodal involvement in our study with respect to tumor staging was, pT1 stage (n=5/49;10.2%) - periportal lymph nodes involved(n=1/5;20%), pT2 stage (n=12/49;24.5%) - pericholedochal (n=3/12;25%), cystic (n=2/12;16.6%),peripancreatic (n=2/12;16.6%),Common Hepatic Artery nodes (n=1/12;8.3%),periportal(n=1/12;8.3)hepato-duodenal nodes(n=1/12;8.3), pT3 stage tumors(n=32/49;65.3%) - peri-pancreatic(n=7/32;21.9%),Common Hepatic Artery (n=6/32;18.7%), periportal (n=5/32;15.6%),hepato-duodenal(n=4/32;12.5%),celiac (n= 2/32;6.25%),pericholdecochal (n=1/32;3.1%), LHA nodes (n=1/32;3.1%),RHA nodes(n=1/32;3.1%),cystic lymph nodes (n=1/32;3.1%) with p>0.05. [Extracted from the article]

The current study sought the effective mitigation measure of seawater-induced damage to mung bean plants by exploring the potential roles of acetic acid (AA). Principal component analysis (PCA) revealed that foliar application of AA under control conditions improved mung bean growth, which was interlinked to enhanced levels of photosynthetic rate and pigments, improved water status and increased uptake of K+, in comparison with water-sprayed control. Mung bean plants exposed to salinity exhibited reduced growth and biomass production, which was emphatically correlated with increased accumulations of Na+, reactive oxygen species and malondialdehyde, and impaired photosynthesis, as evidenced by PCA and heatmap clustering. AA supplementation ameliorated the toxic effects of seawater, and improved the growth performance of salinity-exposed mung bean. AA potentiated several physio-biochemical mechanisms that were connected to increased uptake of Ca2+ and Mg2+, reduced accumulation of toxic Na+, improved water use efficiency, enhanced accumulations of proline, total free amino acids and soluble sugars, increased catalase activity, and heightened levels of phenolics and flavonoids. Collectively, our results provided new insights into AA-mediated protective mechanisms against salinity in mung bean, thereby proposing AA as a potential and cost-effective chemical for the management of salt-induced toxicity in mung bean, and perhaps in other cash crops. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 52-year-old man with abdominal pain associated with palpable lump in right upper abdomen. Topics include diagnosed with gallstone-related acute necrotising pancreatitis and undergone surgical necrosectomy, positive plasma cells of a rare disease IgG4 after immunohistochemistry (IHC) and reporting of rare benign lesion of the liver IgG4-related inflammatory pseudotumor (IP) in patients with sclerosing cholangitis (SC) or autoimmune pancreatitis (AIP).

The article describes the case of a 38-year-old male patient diagnosed with renal mucormycosis. Topics discussed include the symptoms exhibited by the patient, the pathological signs of mucormycosis and the reasons for the need to use fine needle aspiration in investigating the lesions. Also discussed is the use of antifungals to treat the patient and surgical debridement to remove infected tissues.

The article presents a case study of a 60-year-old female patient with progressive dysphagia. It mentions that contrast enhanced computed tomography was performed which showed smooth circumferential mural thickening and highlights that positron emission tomography/computed tomography (PET/CT) was performed to check for evidence of malignancy. It reports that the fluoro-deoxy-glucose (FDG) uptake was evident during the entire length of the thoracic oesophagus.