Bilateral adrenal cortical rests: An interesting innocuous intruder in the fallopian tubes.

ABSTRACT: Ectopic adrenal rests refer to the presence of adrenal tissue outside its normal anatomical location and are usually discovered incidentally on microscopic examination. Literature suggests its occurrence in diverse extrarenal sites, like the genitourinary system and pelvis. Our case describes the rare occurrence of ectopic adrenal rests in the walls of bilateral fallopian tubes of a 43-year-old female patient who presented with a complaint of heavy menstrual bleeding. A total hysterectomy with bilateral salpingo-oophorectomy was performed. Gross examination revealed adenomyosis with multiple fibroids, and the same was confirmed on microscopy. Additionally, the finding of a well-encapsulated lesion on the walls of both tubes made us relook at the fallopian tubes, which showed a small bright yellow area measuring less than 0.3 cm in the walls, which was consistent with ectopic adrenal rests after ruling out the morphological differentials of Walthard cell nests, aggregates of foamy histiocytes, metastatic renal clear cell carcinoma, displaced ovarian luteinized theca cells, heterotopia of ovarian hilus cells. Immunohistochemistry showed positivity for Melan A and CK7 was negative. The present case helps in investigating the lesser-explored aspect of adrenal rest pathology. It also reiterates need for detailed observation of fallopian tubectomy specimens by pathologists during grossing to avoid overlooking of potentially intriguing entities.

Correlação entre resistência de preensão manual e resistência muscular escapular em indivíduos assintomáticos / Correlation between hand grip endurance and scapular muscle endurance in asymptomatic individuals

INTRODUÇÃO: A atividade de preensão é uma ação diária essencial em casa e no local de trabalho, onde muitas vezes é necessário levantar e segurar cargas com uma preensão relativamente estática usando contração isométrica. A força e resistência muscular no aspecto proximal das extremidades superiores influenciam na função da mão, e indivíduos com força e resistência reduzidas são mais propensos a desenvolver distúrbios musculoesqueléticos relacionados ao trabalho. Uma boa resistência de preensão pode ser influenciada pela estabilização fornecida pelos músculos do ombro. Este estudo tem como objetivo determinar a extensão da correlação entre resistência de preensão manual e resistência muscular da escápula em jovens assintomáticos. MÉTODO: O tamanho da amostra para este estudo foi n = 62, com base em estudos anteriores. Indivíduos saudáveis, com idade entre 18 e 25 anos, de ambos os sexos, foram incluídos. Uma avaliação objetiva da resistência da preensão foi realizada usando um dinamômetro manual hidráulico, e a resistência escapular foi avaliada usando o teste muscular escapular. RESULTADOS: A análise de dados foi realizada usando o SPSS versão 20. Houve correlações positivas significativas entre as medidas de resistência escapular e a resistência de preensão palmar para ambos os lados (teste de correlação de Pearson, r = 0,612 (p < 0,001) e r = 0,524 (p < 0,001), respectivamente, para resistência de preensão da mão não dominante e dominante). CONSIDERAÇÕES FINAIS: Os achados preliminares deste estudo sustentam que a resistência do músculo escapular exibe uma relação com a resistência da preensão palmar, sugerindo que o treinamento de resistência escapular pode ser um complemento eficaz no processo de reabilitação das funções da extremidade superior.

INTRODUCTION: Gripping activity is an essential daily activity at home and at the workplace, where lifting and holding loads with a relatively static grip using isometric contraction is often required. Muscle strength and endurance in the proximal aspect of the upper extremities influence hand function, and individuals with reduced strength and endurance are more prone to developing work-related musculoskeletal disorders. Good grip endurance might be influenced by the stabilization provided by shoulder muscles. This study aims to determine the correlation between hand grip endurance and scapula muscle endurance among young asymptomatic individuals. METHOD: The sample size for this study is n = 62, based on previous studies. Healthy individuals of both genders, aged between 18 and 25 years, were included. An objective assessment of grip endurance was performed using a hydraulic hand dynamometer, while scapular endurance was evaluated using the scapular muscle test. RESULTS: Data analysis was performed using SPSS version 20. There were significant positive correlations between scapular endurance measures and the hand grip endurance on both sides (Pearson correlation test, r = 0.612 (p < 0.001) and r = 0.524 (p < 0.001), respectively, for non-dominant and dominant hand grip endurance). FINAL CONSIDERATIONS: The preliminary findings of this study support the notion that scapular muscle endurance is related to hand grip endurance, suggesting that scapular endurance training may be an effective adjunct in the rehabilitation process for upper extremity functions.

A Rare Case of Primary Plasma Cell Leukaemia with Monosomy X.

Primary Plasma Cell Leukaemia (pPCL) is a very rare and aggressive subtype of plasma cell dyscrasias with a very poor outcome and characterized by presence of >2x109/l circulating plasma cells. Overall incidence being 1%-2% of all malignant plasma cell diseases and 0.9% of all acute leukaemias. Patients with primary and secondary PCL have similar clinical features but differences do exist. Here we report a rare and interesting case diagnosed as primary PCL in a 44-year-old female with unusual clinical presentation and complex karyotyping. Her serum electrophoresis showed a monoclonal IgG component and immunohistochemistry of bone marrow plasma cells showed CD 38 positive and CD 20 negative. The patient initially responded partially for combination chemotherapy, but succumbed after 20 days of diagnosis. We are presenting this case to highlight the importance of early diagnosis of such haematological malignancies in settings where treatment options like stem cell transplantation are limited.

Isolated Skull Metastasis of Follicular Carcinoma Thyroid in an Elderly Female: A Rare Case.

Isolated skull metastasis from a well differentiated follicular thyroid carcinoma, as the presenting feature is a rare manifestation. We report a case of a 79-year-old female who presented to us with only a painful, gradually increasing scalp swelling with associated pain and blurring of vision over the past few days. Neuroimaging findings strongly favoured a diagnosis of meningioma. A bifrontal craniotomy was performed and the tumour was excised. Histopathological examination of the same showed, it to be a case of metastatic thyroid carcinoma. We present this case not only because of the diagnostic challenge it posed, but also because the patient in our case is one of the oldest case of skull metastasis from follicular thyroid carcinoma till date.

Xanthogranulomatous Cholecystitis with Florid Ducts of Luschka: Double Trouble Mimicking Malignancy.

Xanthogranulomatous Cholecystitis (XGC) is an uncommon inflammatory condition of gall bladder, which is often misdiagnosed as malignancy preoperatively, leading to extensive surgical resections which may not be necessary for the patient. Ducts of Luschka are a rare developmental variant of the biliary tree, which are prone to injury and bile leak during cholecystectomy. We report a case of a 52-year-old male patient who was taken up for surgery with a provisional diagnosis of chronic calculous cholecystitis. Intraoperative finding of dense adhesions, made the surgeons suspect malignancy. On histopathological examination, it was not only diagnosed as a case of XCG, but it also had florid ducts of Luschka, another rare variant needing documentation as it is a close mimicker of malignancy.

Role of fine-needle aspiration cytology in the diagnosis of major salivary gland tumors: A study with histological and clinical correlation.

INTRODUCTION: Neoplastic lesions of salivary glands present an interesting subject because of their histologic diversification. Complex features exhibited by them have aroused considerable speculations concerning their histogenesis and continues to hold the interest of clinicians and pathologists. Major salivary glands are superficial and have easy accessibility for fine-needle aspiration cytology (FNAC). These glands are generally not subjected to incisional or core needle biopsy, because of the possible risks of fistula formation and tumor seedling. FNAC diagnosis of major salivary gland neoplasms aids in proper planning of required surgery and avoidance of the same in cases of non-neoplastic lesions. MATERIALS AND METHODS: Cytological features of major salivary gland tumors diagnosed on FNAC were studied over a period of one and a half years. Cytological and architectural patterns in smears were compared with histopathological features in cases where the specimens were available with a note on the age, sex and presenting complaints. STATISTICAL ANALYSIS: Analysis of variance (ANOVA) was used to find the significance of study parameters. Chi-square/Fisher Exact was used to find the significance of study parameters on categorical scale between two or more groups. P value of <0.05 was considered to be significant. RESULTS: A total of 114 salivary gland FNACs were done, 75 patients were clinically suspected to be neoplasms. The peak incidence was in the third to fourth decade of life with a female preponderance. Parotid was the most commonly affected gland (80%) with pleomorphic adenoma and mucoepidermoid carcinoma (10.7%) being the most common benign and malignant tumors respectively. The diagnostic accuracy of FNAC was 97.6%. Warthins tumor was misdiagnosed and was associated with a strong smoking history. CONCLUSION: Salivary gland neoplasms constitute a small but significant percentage of head and neck tumors. FNAC is inexpensive, quick, and aids in the preoperative diagnosis and planning of surgery.

Crystallizing galactocele: Report of a rare variation.

The physiological changes of the breast during pregnancy and lactation make the clinical, radiological and pathological evaluation of a breast mass challenging. Galactoceles are benign lesions containing milk, and generally occur post partum. Fine needle aspiration cytology is a simple, quick and effective technique for the diagnosis of the same during this period, and in case of galactocele the same can be both diagnostic and therapeutic.Although the cytological features of galactocele are straight forward, a few rare interesting variations can be encountered posing a diagnostic challenge to the reporting cytopathologist. We present a case of galactocele in a twenty five year old lactating female with tyrosine crystals on cytology. Milk is composed of a wide variety of proteins and minerals, leading to the formation of calcium lactate or tyrosine crystals under rare circumstances when the milieu is acidic. This is one of the rare cases of crystallizing galactoceles reported in literature till date.

Basal cell adenoma of the parotid gland: Cytological diagnosis of an uncommon tumor.

Basal cell adenoma (BCA) is a rare benign epithelial tumor of the salivary gland, displaying monomorphic basaloid cells without a myxochondroid component, representing 1-3% of all salivary gland neoplasms seen predominantly in women over 50 years of age. It is uncommon in young adults. Cytodiagnosis of basaloid tumors chiefly basal cell adenoma of the salivary gland, is extremely challenging. The cytological differential diagnoses range from benign to malignant, neoplastic to non- neoplastic lesions. Histopathological examination is a must for definitive diagnosis, as these entities differ in prognosis and therapeutic aspects. We present a 22-years-old male with this uncommon diagnosis with a discussion on the role of cytological diagnosis. Fine needle aspiration cytology is a simple, minimally invasive method for the preoperative diagnosis of various types of neoplastic and non-neoplastic lesions. The knowledge of its pitfalls and limitations contributes to a more effective approach to treatment.

Necrotizing Sialometaplasia of the Hard Palate: A Rare Entity of Dilemma on Cytology, Confirmatory on Histopathology.

Necrotizing sialometaplasia is a rare, benign reactive necrotizing lesion, involving sites where salivary gland tissue is usually present. The importance of this lesion is that it mimics malignancy clinically leading to treatments ranging from conservative excision to total maxillectomy. Cytologically and histologically also the lesion is often confused with neoplasms. We present a case of a lady with a hard palatal swelling, which was non - ulcerative unlike typical cases of necrotizing sialometaplsia. FNAC features made us strongly suspect a low grade mucoepidermiod carcinoma, following which the swelling was excised. Histopathology came to the rescue, on which the final diagnosis of necrotizing sialometaplasia of the hard palate was made. Necrotizing siaometaplasia is often misdiagnosed by the inexperienced cytologist, with histopathological examination being confirmatory. We also emphasize the fact that lesions like necrotizing sialometaplasia need a high degree of suspicion along with clinical co relation before subjecting the patient to unnecessary surgical procedures.

Amelanotic melanoma masquerading as a superficial small round cell tumor: a diagnostic challenge.

Malignant melanoma poses a remarkable capacity for morphological diversity and often presents as a diagnostic challenge due to its wide clinical presentation. We present a case of a 73-year-old lady, with a large superficial ulcerative nodular mass on the flexor aspect of the right upper arm. On fine needle aspiration poorly differentiated round cell tumor was suggested, with histopathology also supporting the same diagnosis. A final diagnosis of amelanotic melanoma was given following immunohistochemical work-up using a panel of relevant markers. We are presenting this case, not only for its rare clinical presentation, but also for the diagnostic difficulties encountered by us in cytology and histopathology to reach the final diagnosis.

Aggressive Digital Papillary Adenocarcinoma-A rare Entity Posing a Diagnostic Challenge.

Aggressive digital papillary adenocarcinoma (ADPCA) is rare tumor of the sweat glands, which is characterised by lesions on the fingers, toes and the digits. The lesion is serious but often overlooked because it is confused clinically with benign and non-tumorous entities. In this paper, we present an interesting case of ADPCA in a 40-year-old lady, suspected clinically as pyogenic granuloma, with the initial excision biopsy indicating a malignant tumor in the sweat gland. Ray amputation of the affected finger was done followed by a thorough work up to rule out metastasis. Histopathological features were studied in detail, along with required markers. We present this case as the documentation of this malignant tumor is limited in literature and also it requires a high index of suspicion when dealing with all masses arising on the digits.

Isolated primary renal echinococcosis: a rare entity.

Primary renal echinococcosis, a rare entity in diseases involving the kidney, accounts for 2-3 % of all cases. We present a case of 37-year-old female presenting with pain in the right iliac fossa. Radiologically, both ultrasound abdomen and CECT diagnosed as hydatid cyst, mild to moderate hydronephrosis, proximal hydroureterosis, and a possibility of rupturing into the pelvicalyceal system. Renal sparing surgery is the treatment of choice in most cases (75 %) with nephrectomy being reserved for non-functioning kidney as in our case. Histopathological examination of the nephrectomy specimen confirmed the diagnosis.

An enhanced recovery programme reduces length of stay after rectal surgery.

PURPOSE: Enhanced Recovery Programmes (ERP) result in shorter hospital stay after colonic resection with no increase in complication, mortality or readmission rates. There is little data regarding the use of an ERP after rectal resection. We investigated the effect of introducing laparoscopic surgery and the ERP on outcomes in our unit. METHODS: From February 2007, elective patients undergoing rectal resection (laparoscopic or open) under the care of two colorectal surgeons were placed into the ERP. Length of stay (LOS) was recorded as total LOS, including readmissions. Comparison was made with a cohort of patients from 2004-2005 before the onset of laparoscopic surgery/ERP. RESULTS: Forty patients in the ERP group were compared with 42 patients from 2004-2005. Morbidity and mortality rates were similar. LOS was shorter in the ERP group cf. the retrospective group (median 7 days vs. 11 days; p=0.002). Median LOS was shorter in both laparoscopic ERP patients (6 days cf. 11 days; p= 0.004) and open ERP patients (7 days cf. 11 days; p=0.014) cf. the retrospective group. CONCLUSION: Patients having rectal resections benefit from a multimodal approach to surgery with significant reductions in LOS, but no change in morbidity or mortality.