Primary extragastrointestinal stromal tumors: a clinicopathological and immunohistochemical study - a tertiary care center experience.

BACKGROUND: Extra gastrointestinal stromal tumors (EGIST) are uncommon compared to their gastrointestinal counterparts. EGISTs involve omentum, mesentery, retroperitoneum, pancreas, and pelvis. MATERIALS AND METHODS: Ten EGISTs were analyzed in this study from January 1995 to November 2011. They were analyzed with respect to clinical features, imageological, histopathological, and immunohistochemical findings. The immunohistochemical stains used were Smooth muscle actin (SMA), Desmin, S-100 protein, CD34 and CD-117. RESULTS: There was slight female preponderance with wide age range. Four of the tumors were in retroperitoneum, three in mesentery, and two in omentum and one in pelvis. Histopathologically majority were spindle cell tumors. Immunohistochemically CD117 was consistently positive followed by CD34. Smooth muscle actin was positive in eight cases, S-100 protein and desmin were positive in two cases each. CONCLUSION: EGISTs are rare and should be considered in the differential diagnosis of the mesenchymal tumors and immunohistochemistry helps to confirm the diagnosis. Further study with better follow-up is desired to characterize these uncommon tumors.

Swyer syndrome: a case report with literature review.

Gonadoblastomas are known to develop in dysgenetic gonads, especially so, if Y chromosome material is present. A 20-years-old girl who noticed breast development since the age of 12 years presented with primary amenorhoea, distension of lower abdomen and intermittent pain for two months. She had breakthrough bleeding with six months of estrogen replacement. Tanner breast stage was five and pubic hair stage was also five. Examination revealed a mass in the lower abdomen extending into hypogastrium, umbilical and lumbar regions. Her gonadotropin levels were grossly elevated. Karyotyping showed 46XY. CT scan of abdomen showed a 17X11 cm mass in the pelvis without visible gonads. Surgical excision of the mass along with bilateral salpingophorectomy was performed. Histopathology revealed the mass to be a dysgerminoma, while the right gonad lodged gonadoblastoma. She was diagnosed as a rare case of Swyer syndrome.

Part 2. Time-series study on air pollution and mortality in Delhi.

INTRODUCTION: Air pollution concentrations in most of the megacities in India exceed the air quality guidelines recommended by the World Health Organization and may adversely affect human health in these cities. Particulate matter (PM) is the pollutant of concern in many Indian cities, particularly in the capital city of Delhi, In recent years, several actions have been taken to address the growing air pollution problem in Delhi and other Indian cities; however, few studies have been designed to assess the health effects of air pollution in Indian cities. To bridge the gap in scientific knowledge and add evidence to the ongoing studies in other Asian cities, a retrospective time-series study on air pollution and mortality in Delhi was initiated under the HEI Public Health and Air Pollution in Asia (PAPA) program. APPROACH: The study used retrospective time-series data of air quality and of naturally-occurring deaths recorded in Delhi to identify changes in the daily all-natural-cause mortality rate that could be attributed to changes in air quality. The 3-year study period included the years 2002 through 2004. The methodology involved: (1) collecting data on ambient air quality for major pollutants from all monitoring stations in Delhi; (2) collecting meteorologic data (temperature, humidity, and visibility); (3) collecting daily mortality records from the Registrar of Births and Deaths; (4) statistically analyzing the data using the common protocol for Indian PAPA studies, which included city-specific modifications. RESULTS AND IMPLICATIONS: The study findings showed that increased concentrations of PM with an aerodynamic diameter < or = 10 microg/m3 (PM10) and of nitrogen dioxide (NO2) were associated with increased all-natural-cause mortality. It was found that every 10-microg/m3 change in PM10 was associated with only a 0.15% increase in total all-natural-cause mortality. When NO2 alone was considered in the model, daily all-natural-cause mortality increased 0.84% for every 10-microg/m3 increase in NO2 concentration. No significant effect was observed for changes in sulfur dioxide (SO2) concentrations. The study provides insight into the link between air pollution and mortality in local populations and contributes information to the existing body of knowledge.