Primary Splenic Pregnancy- A Rare but Imperative Cause of Hemoperitoneum - Case Report and Review of Literature.

Primary splenic pregnancy is an extremely rare form of extratubal ectopic pregnancy. These cases often cause splenic rupture in very early course of their gestation thereby presenting with hemoperitoneum in emergencies. Owing to the higher risk of exsanguination and death caused by hemoperitoneum, it is essential to diagnose these cases for proper management and better prognosis of the patients. We present the case of a 23-year-old female, gravida 2, para 1, live issue 1 presenting to the emergency outpatient department with acute abdomen and hemoperitoneum. There was no history of trauma. The patient had a positive urine pregnancy test and raised beta HCG levels. Emergency laparotomy revealed an otherwise unremarkable fallopian tube and ovary with a hemoperitoneum of 2.5 liters. A tiny splenic laceration was considered to be the source of bleeding and splenectomy was performed. Microscopy was suggestive of a primary ectopic pregnancy, spleen. Since hemoperitoneum in pregnancy is a rare but potentially fatal condition with a high risk of mortality, an accurate preoperative diagnosis is crucial in the management of such patients. The possibility of a ruptured extratubal ectopic pregnancy must be considered as one of the differential diagnoses of acute abdomen with hemoperitoneum in women of childbearing age.

Giant Anterior Neck Lipoma with Bleeding Pressure Ulcer in an Elderly Man: A Rare Entity.

Giant lipomas are benign soft tissue tumors found rarely in the neck and are still rarer in the anterior part of the neck. A 70-year-old male patient was presented with a huge swelling measuring 35 cm in maximum dimension, in the front of the neck, reaching up till the umbilicus. The swelling was painless, slow growing and acquired the huge size in approximately 20 years. Ultrasound and CT scan findings were suggestive of a soft tissue lesion. Fine needle aspiration cytology yielded mature adipose tissue fragments. A complete surgical removal of the mass was done which on gross examination, measured 32 cms in longest diameter and weighed 2500 grams. Diagnosis of giant anterior neck lipoma with pressure ulcer was confirmed on histopathology. We described a case of excessively large lipoma of anterior neck, which is the largest anterior neck lipoma with pressure ulcer reported till date.

Sclerosing polycystic adenosis: A rare tumor misdiagnosed as retention cyst on fine needle aspiration cytology.

Sclerosing polycystic adenosis (SPA) is a rare benign neoplasm of the salivary gland which resembles the fibrocystic disease of the breast clinically as well as morphologically. This entity has varied morphological presentation on fine needle aspiration. Only a few case reports and occasional case series are found in the literature describing its cytology. Here we are presenting a case of SPA in the parotid gland in a 13-year-old male patient who presented with a slow growing infra-auricular mass since one year without any other symptoms. Radiological investigation suggested a possibility of matted level II cervical lymph nodes. Fine needle aspiration of the same showed only crystalloids in a dirty background. Hence, a possibility of retention cyst was given and excision was advised. On histopathological examination, the mass was diagnosed as Sclerosing polycystic adenosis of the parotid gland. Since SPA is a rare entity with diverse morphological features, it is more likely to be misdiagnosed on cytology. Recognition of this benign entity is important since the differential diagnosis includes other more common benign and malignant salivary gland neoplasm particularly mucoepidermoid carcinoma and other tumors with cystic and oncocytic features. Repeat aspiration from multiple sites should be considered in cystic lesions of the salivary gland so that its varied cytological components can be yielded to help with the diagnosis. Diagn. Cytopathol. 2017;45:640-644. © 2017 Wiley Periodicals, Inc.

Intestinal Type Adenocarcinoma from Inverted Papilloma: A Rare Recurrence.

Inverted Papilloma (IP) is an uncommon and locally aggressive benign tumour of sinonasal region, which tends to recur after surgical resection. Most tumours are confined to the lateral nasal wall and sinuses, with maxillary sinus being most commonly affected and a male preponderance. It has a known association with in situ and invasive carcinomas with a <10% rate of malignant transformation. Most common association has been seen with squamous cell carcinoma and extremely rare association with adenocarcinoma and small cell carcinoma. A 36-year-old male presented with a left sided polypoidal nasal mass and underwent a polypectomy. Pathology results showed IP with mild dysplasia. The polypoidal growth reappeared on the same side after a period of 10 months and on histopathological examination, the growth revealed features of intestinal type adenocarcinoma. IP recurring as adenocarcinoma is rare and even after exhaustive literature search only few cases could be found. Two studies have described recurrence of adenocarcinoma in existing IP previously. We report an unusual case of inverted papilloma showing malignant transformation into an intestinal type adenocarcinoma in a 36-year-old male patient within 10 months of previous surgery.

Pregnancy Associated Breast Cancer: Awareness is the Key to Diagnosis -A Case Report.

Pregnancy-associated breast cancer (PABC) is defined as breast cancer that occurs during pregnancy or within one year of delivery. PABCs are typically found at advanced stage and are reported to have higher recurrence and mortality rates as compared to non PABC. Although it is said to be rare its incidence is increasing. Very little data is available on PABC among Indian women. Delay in diagnosis is one of the major causes of aggressive presentation of PABC. This is due to the fact that most of the lesions presenting during this period are benign and lactational changes hamper the detection of mass clinically as well as by various investigative methods. Paget's disease of breast, usually reported in elderly woman, when occurs in lactating breast may mimic benign eczematous lesion. Increased awareness among patients as well as clinicians is required to detect this highly aggressive form of breast cancer at an early and treatable stage. Treatment is by multidisciplinary approach and depends upon the gestational stage. Here we report a case of PABC in a lactating woman presenting with Paget's disease because such case may be under diagnosed as breast feeding related lesion leading to delayed diagnosis.