Borderline phyllodes tumor arising in ectopic breast tissue in the axilla: Report of a rare case with brief review of literature.

Development of a neoplasm in an ectopic breast is uncommon, while the development of phyllodes tumor in an ectopic breast in the axilla is even rarer. We report a rare case of a 51-year-old female who presented with a complain of swelling and pain in the right axilla with no associated complaints in other organs. Magnetic resonance imaging suggested a possibility of metastatic lymphadenopathy. Complete excision of the right axillary mass was performed and sent for histopathological examination which was examined thoroughly and sections were given. On microscopic examination, stromal proliferation in a leaf-like pattern with mild stromal atypia and focal permeation of borders were seen, and a diagnosis of Ectopic borderline phyllodes tumor in axilla was made, which is extremely rare and needs to be differentiated from its close differentials like fibroadenoma and periductal stromal sarcoma.

Therapeutic lessons from transfusion in pregnancy-effect on hematological parameters and coagulation profile.

INTRODUCTION: Transfusion is commonly done in clinical indications and complications arising due to Anemia, shock, blood loss, thrombocytopenia due to any cause, ineffective erythropoiesis. Pregnancy is a physiological condition characterized by Anemia, fluid overload, hypercoagulable state, and antifibrinolytic condition, which can cause various reactions that could be anticipated during a blood transfusion. With an aim to understand the effects of transfusions on hematological parameters in pregnancy. The results of whole blood and component transfusion were studied to understand increments and their effects so that rationalized transfusion decisions during pregnancy can be undertaken, considering the physiological changes in pregnancy on hemodynamics are present. METHODOLOGY: A prospective study with 80 pregnant females undergoing blood transfusion was studied. Their coagulation and hematological profile were correlated to derive a conclusion for the effect of transfusion of blood and its products. RESULTS: A mean increment of 0.55+0.07 g/dL hemoglobin (Hb) was noted along with a slight increase in RBC count (0.25+0.07 millions/mm3), hematocrit (HCT) (1.9+0.42%), TLC (400+565 cells/mm3). This statistically significant mean increase in hemoglobin, RBC count, and hematocrit was significantly lower than that compared to studies in the west and non-anemic patients. A mean increment of 7.79+1.51 µg/dL (statistically significant) in serum iron was seen. A significant improvement in their coagulation profile was achieved by plasma transfusion (FFP). Clotting time (CT) decreased by a mean value of 196.43+56.69 secs and prothrombin time (PT) by 2.64+0.63 secs (P<0.05). All transfusion reactions in our study were associated with PRBC transfusion, non-hemolytic immunological type, urticarial transfusion reactions (UTR) more common in multiparous women-0.2% in primigravida to 21.7% and 37.5% in 3rd and 4th parity similar to that observed in other studies. CONCLUSION: Although different researchers have done numerous studies, the physiological profile of pregnant females in India is markedly different in nutritional profile, ethnicity, environmental factors, and background. The availability of tertiary care medical facilities during ANCs is also known to affect pregnancy outcomes and the presentation of patients at term or in labor. The variety of factors affect the baseline hematological status of pregnant females and, hence, post-transfusion hematological factors. These are therefore markedly different from prior published studies. It is concluded that PRBC transfusion in pregnant women causes a lower increase in mean Hb and HCT values than in the west, and ferritin and serum iron are not reliable indicators of Anemia in transfusion. Due to lower increments in all values except platelets could be the reason for this could be contributed by confounding factors like Anemia, hyperfibrinogenemia, volume overload, and ethnicity.

Interaction of aminophylline with photoilluminated riboflavin leads to ROS mediated macromolecular damage and cell death in benzopyrene induced mice lung carcinoma.

Riboflavin (Rf) or vitamin B2 is a known photosensitizer whose photophysical and photochemical properties are well established. Aminophylline (Am) is a phosphodiesterase inhibitor and is currently used as a bronchodilator. Although there are several reports of haemolytic and proteolytic interaction of photoilluminated riboflavin with aminophylline, the cytotoxicity of this system against malignant tissue is not well defined and fully unravelled. Here, we are evaluating anticancer activity of this system against B(a)P induced lung carcinoma in swiss albino mice. We observed marked increment in the level of cellular redox scavengers as well as oxidative stress markers. A significant DNA damage was observed using comet assay. Histopathological studies further confirmed induction of apoptosis in lung tissues of Am-Rf treated animals. Scanning electron microscopy revealed altered surface morphology of the malignant tissue, which characteristically improved in the treatment group. Since malignancy is characterised by compromised redox status, therefore, further increment in ROS due to the action of this system derives cellular system towards extensive macromolecular damage and consequent ROS mediated apoptosis. We anticipate the usage of this system in developing efficient photodynamic therapy against lung cancer that can be clinically realised.

Study of Hemolysis During Storage of Blood in the Blood Bank of a Tertiary Health Care Centre.

The aim of RBC storage system in a blood bank is to counteract damage to the metabolic machinery and the membrane, to improve post-transfusion viability. In recent years, the need for strict control over the quality of blood has been emphasised. Such quality indicator includes extend of hemolysis and morphological changes of RBC during storage. This study was design to see extend of hemolysis and level of plasma lactate dehydrogenase (LDH) and plasma potassium, during processing and storage at different intervals under blood bank condition. Forty-six donors were selected and blood units were collected and stored under blood bank conditions. Mean plasma haemoglobin of stored blood was estimated by tetra methyl benzidine method (TMB) and percentage hemolysis was calculated on day 0, 1, 7, 21, 28, 35 and 42 days. Similarly plasma LDH and plasma potassium level was also assessed during storage. It was noted that free haemoglobin level and percentage hemolysis progressively increased with storage along with the level of LDH and potassium. However, extend of hemolysis did not exceed the permissible limit of 0.8% up to 42 days of storage. 15 blood bags which showed visual hemolysis on day 28 did not exceeded the threshold of 0.8% hemolysis, when interpreted by TMB method. It was concluded that TMB method is better than visual method for determination of hemolysis. The reduced hemolysis at this centre may be accounted for the use of additive solution SAGM (Saline, Adenine, Glucose, Mannitol) and DEHP (di-2-ethyl hexyl phthalate) as plasticizer in blood bags for storage.

Primary hydatid disease of the breast clinically masquerading as a galactocele: A case report.

We report a rare case of a 30-year-old breastfeeding woman who presented to our surgical outpatient department with complaints of a gradually enlarging lump in her left breast for the last 2 months. She also complained of difficulty in breastfeeding for 1 week. On examination, the right breast was normal but there was a 4 cm × 4 cm retroareolar soft lump in her left breast. Examination of the bilateral axilla was normal. A provisional diagnosis of galactocele was made and the patient was subjected to ultrasonic mammography and fine needle aspiration cytology (FNAC). Ultrasonic mammography of the left breast showed a heterogeneous, hypoechoic lesion with thick septations and internal echoes suggestive of a complex cystic lesion, leading to a differential diagnosis of either hydatid cyst or breast abscess. On FNAC, the aspirate was not milky and cytological examination was performed, which revealed hydatid scolices, hooklets, foamy macrophages and granular debris, leading to the final diagnosis of hydatid cyst of the breast. The patient was investigated further but there were no cysts at any other site. Chemotherapy with albendazole was started and surgery was performed after 1 month. Histopathology further confirmed the diagnosis. Owing to the rarity of presentation, this case is being reported here.

Metastatic adenocarcinoma of the mandible-a rare entity.

Metastasis of the liver and lung malignancies to the jaw bones is very rare and the mandible is the commonest site of involvement. The frequent primary sites for metastasis to jaw bones are breast in females and lungs in males. This is a case report of the metastatic adenocarcinoma of the mandible which originated from liver or lung. Diagnosis of such metastatic lesions is difficult and challenging to identify the primary site.

Steatocystoma multiplex.

A 40-year-old man presented with multiple papules on his head and neck. The lesions had been present for about 15 years. The patient was treated for acne for 6 months, but no improvement was noted. A biopsy was performed and microscopic findings were consistent with steatocystoma multiplex.