Incidental Gall Bladder Carcinoma in Patients Undergoing Cholecystectomy: A Report of 7 Cases.

BACKGROUND: Carcinoma gall bladder accounts for 98% of all the gall bladder malignancies and is the sixth most common malignancy of the gastrointestinal tract worldwide. Incidental gall bladder carcinoma (IGBC) is an incidental finding of carcinoma diagnosed during a laparoscopic cholecystectomy or on histopathological examination of gall bladder specimen removed for benign gall bladder diseases. The incidence of IGBC is around 0.19 - 3.3% in the literature. OBJECTIVES: The aim of the present study was to report our experience with gall bladder cancers which were incidentally diagnosed during histopathological examination of cholecystectomy specimens done for benign gall bladder disease and follow up of the cases. MATERIAL AND METHODS: This study includes 270 cholecystectomy specimens which were removed, during June 2010 to July 2011 in a tertiary care hospital. The clinicopathological findings of cases with incidentally detected gall bladder cancers were recorded; age, sex, presenting symptoms, presence of gall stones and histologic grade and staging of tumours were included. Exclusion criteria included preoperative suspicion of malignancy before cholecystectomy. American joint committee on cancer (AJCC) staging system was used for staging incidental gall bladder carcinoma. RESULTS: In our study laparoscopy or open cholecystectomy was attempted in 270 cases during the one year period. Incidental gall bladder carcinomas were diagnosed in 7 cases (2.59%), with mean age of 50 years. Pain, vomiting, and dysphagia were the presenting complaints. USG revealed thickened gall bladder in 6 cases, and polyp in one case. Gall stones were seen in 6 cases. Histopathology showed moderately differentiated adenocarcinoma in all the cases. AJCC staging of gall bladder carcinoma revealed 6 cases in pT2 stage and pT1 a stage in one case. On follow up at 22 months, 6 cases were alive while one expired due to tumour metastasis. CONCLUSION: Prognosis of incidental gall bladder carcinoma is better, if diagnosed in early stages.

A Rare Co-existent Case of Splenic Microfilariasis and Pancreatic Solid Pseudopapillary Epithelial Neoplasm - A Double Jeopardy!

Filariasis is a major public health concern in tropical and subtropical countries like India with Wuchereria bancrofti accounting for 90% of lymphatic filariasis. Rarely observed are extra lymphatic manifestations caused by interaction of immune system with microfilaria and their diffusible products. Among various organs involved, splenic involvement is a rare extra lymphatic manifestation of filariasis and can masquerade clinicoradiologically as metastasis when associated with a known malignancy or as a primary malignancy like lymphoma. Hereby, we present an unusual case of coincidence of splenic filariasis with pancreatic solid pseudopapillary epithelial neoplasm in a 20-year-old woman associated with peripheral blood eosinophilia.

Solid pseudopapillary tumor of the pancreas.

Solid pseudopapillary tumor of the pancreas is considered to be a rare pancreatic tumor. These tumors are typically present in women in their third decade of life. The tumors have a low malignant potential. We report a case of 22-year-old female who presented with intermittent abdominal pain of 3 years duration. Distal pancreatectomy with splenectomy was done as a definitive treatment. The importance of accurate diagnosis and treatment is emphasized.

Atypical stromal cells in inflammatory pseudopolyps--a case report.

Atypical stromal cells have been reported in inflammatory lesions of the gastrointestinal tract. We report a case of ulcerative colitis with pseudopolyps, histology of which showed bizarre stromal cells. These atypical stromal cells simulate malignant cells and pose a diagnostic problem for surgical pathologists. It is therefore important to recognize these benign stromal cells as reactive thereby reducing unnecessary surgery.

Cardiac findings in leptospirosis.

BACKGROUND/AIM: In leptospirosis, although cardiac involvement in the form of ECG changes and myocarditis is known, it is not considered to be significant. This study analysed cardiac changes in leptospirosis. METHODS: Twenty-four hearts from patients who had died from leptospirosis were studied. Detailed gross and light microscopic examination was carried out. RESULTS: Myocarditis was noted in 96% of cases. Endocardial inflammation was seen in 50% of cases. This endocardial inflammation correlates with vasculitis, which is the principal pathogenetic mechanism of the disease. CONCLUSIONS: There is definite cardiac involvement in leptospirosis, which even though not symptomatically evident, may add to the morbidity or be contributory to the mortality associated with the disease. In addition, a possibility of dilated cardiomyopathy as a delayed consequence of severe myocarditis remains, and may need evaluation.