MASC Gets UNMASKED: Visiting a Rare Tumor with Emphasis on Cytomorphological Features.

Background: Secretory carcinoma (SC) is a newly described entity which has been often misdiagnosed earlier as acinic cell carcinoma on cytology. Diagnosing SC was initially based upon identifying the ETV6:NTRK3 fusion gene with the help of fluorescence in situ hybridization (FISH). Lately, with more knowledge of the reliable histomorphology, cytology, and immunohistochemistry features, definitive diagnosis can be confidently made without the help of FISH in almost every case. Materials and Methods: Six histologically confirmed cases of SC were studied. The cytology slides of all the six cases were retrieved and reviewed to identify the characteristic features which could have helped in raising the possibility of SC on fine needle aspiration cytology itself. Cell blocks were also studied, wherever available. Results: Patients were all male with average age of 35.2 years. The six cases in the current study demonstrated at least focal cytoplasmic vacuolization of varying sizes, papillae formations, and bland nuclear features on fine needle aspirate smears. It was also seen that S-100 and mammaglobin immunohistochemistry (IHC) are very helpful in confirming the diagnosis. Conclusions: The results of the current study highlight the cytomorphological features which may help in clinching the diagnosis SC on cytology itself. They also highlight certain cytological features which help to rule out the other differential diagnoses.

Interesting Presentation of Mycosis Fungoides in Staging on F-18 FDG PET/CT.

Mycosis fungoides is the major form of primary cutaneous T cell lymphoma. Its staging is based on the percentage of body surface involvement and biopsy-proven extra cutaneous nodal or visceral involvement. Literature shows F-18 FDG accumulation in disease-involved nodes and viscera with non-specific uptake due to co-existing inflammation limits its specificity. We report an interesting case of mycosis fungoides with bilateral upper limb edema and share its findings on F-18 FDG PET/CT.

An adding up of an exceptionally rare case report: Primary Squamous cell carcinoma of Jejunum from North India.

Squamous cell carcinoma (SCC) of lower gastrointestinal tract is a rare tumor and duodenum is the most common site of involvement. In addition, involvement of jejunum by SCC is further exceptionally rare, and only nominal cases are present world literature. Being a very infrequent finding, a clinician and a pathologist must be aware of this rare entity. Diagnosis requires histopathology along with clinico-radiological correlation since merely histopathology is unable to differentiate between primary and metastatic tumor. Treatment modality is totally different in primary and secondary tumor of lower gastrointestinal tract. Being an extremely rare case of primary SCC of jejunum in an elderly female makes it eligible to be acknowledged at the global platform of medical literature.

Epistaxis: the cause found beyond the nose.

Renal cell carcinoma (RCC) is a malignant disease that is often diagnosed at a metastatic stage. The head and neck represent up to 3% of the metastatic RCC, and the paranasal sinus area is one of the least involved sites. Here, we introduce the case of a 74-year-old female patient who presented with a history of traumatic nasal bleed. A cranial computed tomography scan and magnetic resonance imaging showed a fronto-ethmoidal mass with pachymeningeal involvement. A nasal biopsy from the paranasal sinuses was taken. On histopathological examination, metastatic clear cell carcinoma was the main hypothesis, which later was confirmed to be RCC on immunohistochemistry. On further radiological examination, an exophytic mass was depicted in the kidney's upper and middle pole. The patient had no renal complaints and was asymptomatic. Fronto-ethmoidal sinus is a rare site for metastatic RCC, especially in cases where the patient is asymptomatic. Early detection by keeping RCC metastasis as the differential diagnosis in such cases can lead to early treatment and improve the overall survival of the patient.

Epistaxis: the cause found beyond the nose

Renal cell carcinoma (RCC) is a malignant disease that is often diagnosed at a metastatic stage. The head and neck represent up to 3% of the metastatic RCC, and the paranasal sinus area is one of the least involved sites. Here, we introduce the case of a 74-year-old female patient who presented with a history of traumatic nasal bleed. A cranial computed tomography scan and magnetic resonance imaging showed a fronto-ethmoidal mass with pachymeningeal involvement. A nasal biopsy from the paranasal sinuses was taken. On histopathological examination, metastatic clear cell carcinoma was the main hypothesis, which later was confirmed to be RCC on immunohistochemistry. On further radiological examination, an exophytic mass was depicted in the kidney's upper and middle pole. The patient had no renal complaints and was asymptomatic. Fronto-ethmoidal sinus is a rare site for metastatic RCC, especially in cases where the patient is asymptomatic. Early detection by keeping RCC metastasis as the differential diagnosis in such cases can lead to early treatment and improve the overall survival of the patient.

Symposium summary on "Community Psychiatry and DMHP-An update".

This summary provides details of a one-day symposium, titled 'Community Psychiatry and District Mental Health Program (DMHP)- An update' that was organized jointly by the Departments of Psychiatry and Epidemiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru in collaboration with the Department of Health and Family Welfare, Government of Karnataka on September 3rd 2018. This symposium was supported by Dr. Ramachandra N Moorthy, foundation for Mental Health and Neurological Sciences, NIMHANS, Bengaluru.

Comprehensive simulation platform for a metamaterial imaging system.

Recently, a frequency-diverse, metamaterial-based aperture has been introduced in the context of microwave and millimeter wave imaging. The generic form of the aperture is that of a parallel plate waveguide, in which complementary metamaterial elements patterned into the upper plate couple energy from the waveguide mode to the scene. To reliably predict the imaging performance of such an aperture prior to fabrication and experiments, it is necessary to have an accurate forward model that predicts radiation from the aperture, a model for scattering from an arbitrary target in the scene, and a set of image reconstruction approaches that allow scene estimation from an arbitrary set of measurements. Here, we introduce a forward model in which the metamaterial elements are approximated as polarizable magnetic dipoles, excited by the fields propagating within the waveguide. The dipoles used in the model can have arbitrarily assigned polarizability characteristics. Alternatively, fields measured from actual metamaterial samples can be decomposed into a set of effective dipole radiators, allowing the performance of actual samples to be quantitatively modeled and compared with simulated apertures. To confirm the validity of our model, we simulate measurements and scene reconstructions with a virtual multiaperture imaging system operating in the K-band spectrum (18-26.5 GHz) and compare its performance with an experimental system.

Intra-abdominal primary monophasic synovial sarcoma with hemangiopericytoma-like areas.

We report a case of retroperitoneal intra-abdominal primary monophasic synovial sarcoma (SS) with hemangiopericytomatous (HPC) pattern in a 25-year-old male arising from the triangular ligament on the superior surface of liver encasing the inferior vena cava (IVC) and masquerading as a hepatic tumor. A large heterogeneously enhancing, well defined, lobulated, exophytic lesion was seen involving segment VIII of the liver with foci of calcification in the periphery. A biopsy, followed by total resection of the tumor, showed a spindle cell sarcoma with HPC pattern, which was consistent with monophasic SS on histology and immunohistochemistry. The unusual clinical presentation, radiology, pathology, and differential diagnosis will be discussed in detail.

Penicillin skin testing: a 20-year study at the West Los Angeles Veterans Affairs Medical Center.

Penicillin (PCN) may cause a reaction in up to 10% of the population. No study has examined PCN skin testing longitudinally over a 20-year period. A total of 122 patients underwent PCN skin testing between September 1978 and May 1998. Patients were skin tested with the major determinant, penicilloyl polylysine, and three minor determinants, PCN, benzylpenilloate, and benzylpenicilloate. Ten of a total of 122 patients had positive skin test reactions. Nine reactions were to penicilloyl polylysine and one reaction was to the minor determinant benzylpenilloate. There was a total of four patients (3.6%) with false-negative results on skin testing. PCN skin testing with both the major and minor determinants should be performed when there is a history of PCN allergy, a serious illness, and no suitable alternatives. If either the major or minor determinants are positive without suitable alternative antibiotics, then the patient should undergo desensitization.

Age effects on objective measures of atopy in adult asthma and rhinitis.

A cross-sectional survey of 132 adult men referred to the outpatient allergy clinic at the West Los Angeles Veterans Affairs Medical Center was performed to assess age effects on allergic disease in the elderly. Total serum immunoglobulin E (IgE), immediate hypersensitivity skin testing, and serum eosinophil count were measured in all subjects. Subjects were stratified by age into one of five groups for comparison. In asthma, prevalence of allergy skin test reactivity and mean total serum IgE levels did not decline with advancing age, suggesting that IgE-dependent mechanisms continue to be significant in elderly patients with asthma. In subjects with rhinitis, prevalence of allergy skin test reactivity and mean total serum IgE did decline among elderly subjects relative to younger subjects. However, the prevalence of allergic rhinitis did not decline in the elderly. This suggests that although allergic rhinitis is common in elderly patients, nonallergic causes of rhinitis may become more prevalent with advancing age.