Clinicopathological Spectrum of Xanthogranulomatous Pyelonephritis.

Xanthogranulomatous pyelonephritis (XGP) is an uncommon and distinct type of chronic infective pyelonephritis causing destruction of the kidney, severely affecting the renal function. The perinephric adipose tissue and peritoneum is not uncommonly involved. The study was undertaken to decipher the clinicopathologic spectrum of XGP. Forty cases of XGP were diagnosed on histopathology over a period of 13 years (2005-2017). Relevant clinical details and radiological findings were recorded from the case files. Out of a total of 40 cases, 26 were female and 14 were male with a mean age of 39.5 ± 13.6 years. Flank pain was the most common presenting symptom. All the patients had unilateral disease and underwent nephrectomy for a nonfunctional kidney. Gross examination showed enlarged kidney with replacement of cortico-medullary tissue by yellow nodular areas of fatty tissue and dilatation of the pelvicalyceal system. Thirty-six (90%) cases had nephrolithiasis. Histologically, the characteristic feature was the existence of lipid-laden foamy macrophages. Renal parenchymal involvement was diffuse in majority (31, 77.5%). Two (5.0%) of the patients had coexisting carcinoma in the same kidney. Histopathologic examination gives the definitive diagnosis of XGP which relies on the characteristic morphology. Surgical intervention in the form of nephrectomy is the treatment of choice and offers good treatment outcomes.

Endometriotic stricture of the sigmoid colon presenting with intestinal obstruction.

Endometriosis, a relatively common condition, rarely involves the bowel; even more rarely does it present as a large-bowel stricture with intestinal obstruction. We report the case of a young woman who presented to an emergency department with intestinal obstruction secondary to an endometriotic stricture of the sigmoid colon, without evidence of disease elsewhere in the peritoneal cavity. Although large-bowel obstruction is usually caused by a malignant tumour, it can sometimes result from rare causes such as endometriosis. Symptoms of a cyclical nature may remind the clinician of this possibility.

Submacular hydatid cyst: a case report.

PURPOSE: To report a rare case of submacular hydatid cyst and its surgical management. METHODS: Systemic investigations did not show a hydatid cyst in any other body organ. Serology for Echinococcus granulosus was also negative. Pars plana lensectomy and vitrectomy were done. Removal of the cyst was done with the help of foreign body forceps after debulking with cystostomy and silicone oil tamponade was given. Histopathologic examination showed it to be a hydatid cyst. CONCLUSION: Surgery for a subretinal hydatid cyst cytostomy is a safe treatment modality.

Spectrum of clinico-pathological changes in Barrett oesophagus.

OBJECTIVES: Barrett oesophagus is replacement of squamous epithelium to specialised intestinal metaplasia. It is associated with an increased risk for adenocarcinoma which develops through dysplasia. The aim of this retrospective study was to determine the relative age of occurrence and incidence of dysplasia in this part of our country. METHODS: Between January 1999 and June 2002 we diagnosed 13 cases of Barrett oesophagus. Sections were stained with routine H and E and special stain alcian blue (AB)--PAS at pH 2.5. RESULTS: Out of 55 patients with symptoms of gastro-oesophageal reflux disease, 13 cases were diagnosed as Barrett oesophagus. There were 8 males and 5 females. Majority of the patients (77%) were between 20-40 years of age. At endoscopy, in 84.6% patients, lesions were in the form of islands of red mucosa. On histology examination, in 6 cases, squamous epithelium was replaced by intestinal epithelium containing goblet cells and in 7 cases it was replaced by gastric epithelium. Associated dysplasia was not seen in any of the case, while one case showed associated adenocarcinoma. CONCLUSION: Barrett oesophagus is seen in a younger population amongst Indians. A male predominance is noted, but is not as high as reported in Western literature. There is a paucity of patients with pure dysplasia in Barrett metaplasia. Despite the fact that there are a number of patients presenting with Barrett esophagus and carcinoma, very few patients present with dysplasia, indicating that Barrett oesophagus is a silent disease presenting later as a carcinoma.

AgNORs in squamous cell carcinoma of head and neck.

The number of AgNORs per nucleus correlates with cellular proliferation and independently with malignant change. AgNOR number was studied in 200 cases of squamous cell carcinoma of head and neck, the count increased with increasing grade and the size became smaller and irregular with increasing grade of carcinoma. This study seems to suggest that this method has utility in grading of squamous cell carcinoma of head and neck.

Superficial granulomatous pyoderma: an idiopathic granulomatous cutaneous ulceration.

A 70-year-old male with a superficial granulomatous ulcer is reported. Histopathological findings were the same as those described for superficial granulomatous pyoderma, a recognized variant of classic pyoderma gangrenosum. The differences between pyoderma gangrenosum and its variant superficial granulomatous pyoderma are highlighted.

Non-gestational choriocarcinoma in small intestine.

Choriocarcinoma most commonly arises from intrauterine gestational trophoblastic tissue; non gestational choriocarcinoma is rare. We report a 22-year-old married woman with non-gestational choriocarcinoma in the small intestine. Partial resection of the jejunum and ileum was done, followed by chemotherapy. She was well one year later.

Tuberculous parotitis: a series of five cases diagnosed on fine needle aspiration cytology.

Parotid gland tuberculosis is still a rare entity and has mostly been diagnosed after parotidectomy. We present five cases which were diagnosed on fine needle aspiration cytology (FNAC) and managed medically avoiding surgical intervention.

Epithelioid haemangioendothelioma of the rib--a case report.

Epithelioid haemangioendothelioma is a rare primary malignant tumour of the bone that accounts for less than 1% of all primary bone malignancies. The case discussed here is of a 35 years old male who presented with gradually increasing left infrascapular mass attached to 10th rib. X-ray showed an expansile lytic lesion in 10th rib. On FNA the diagnOsis of fibrous dysplasia or fibrous-histiocytic lesions was suggested. The lesion was excised along with adjacent rib. Histopathological examination showed features of epithelioid haemangioendothelioma. Immunohistochemistry revealed focal factor VIII related antigen positivity.

Hormone receptor status of breast cancer in India: a study of 798 tumours.

The objectives of this study were to document the oestrogen and progesterone receptor (ER & PR) status of breast cancer in the Indian population (as done by immunohistochemistry on paraffin blocks), and correlate the steroid receptor status of breast cancer with all relevant patient and tumour characteristics. Our current data have been compared with previously published data from other centres. In contrast to the higher rates reported in the Western literature, only 32.6% of our tumours were ER positive and 46.1% were PR positive. Tumours were separated into four categories: ER+PR+ (25%), ER+PR- (7.4%), ER-PR+ (21.1%) and ER-PR- (46.5%). ER and PR immunoreactivity increased with advancing age, and correlated with the presence of elastosis. Infiltrating lobular carcinoma, mucinous carcinoma, and mixed tumours were more frequently ER & PR positive. High-grade infiltrating duct carcinomas, pure comedo ductal carcinoma in situ, and medullary carcinoma were predominantly ER & PR negative. The presence of necrosis and lymphovascular invasion showed an inverse relationship with ER and PR reactivity.

Juvenile (calcifying) aponeurotic fibroma of the neck.

A case of juvenile (calcifying) aponeurotic fibroma (JAF) arising in the neck of a 5-year-old female is presented. The lesion was misdiagnosed as fibrous hamartoma of infancy (FHI) on a superficial biopsy prior to total excision of the mass. Only one instance of JAF of the neck has previously been reported; the tumor is usually located in the distal extremities and often recurs following excision. FHI occurs most frequently at and about the axilla and shoulder, and does not recur in most instances.

Actinomycotic cholecystitis.

Actinomycotic cholecystitis is rare. We report a 65-year-old woman who was admitted with repeated attacks of pain in the abdomen and vomiting. Clinical and laboratory findings suggested the diagnosis of cholecystitis with cholelithiasis. At cholecystectomy the gall bladder was inflamed with a small perforation, and contained many calculi. Gram's staining of the gall bladder wall revealed Gram-positive actinomycotic colonies.