Giant cell tumour of the anterior arc of a rib presenting as a breast lump: a case report.

Giant cell tumour (GCT) of the anterior arc of a rib is a very rare occurrence and quite often the diagnosis is delayed. We report a case of GCT of a rib arising from the anterior arc which presented as a breast lump. The diagnosis of GCT was considered in the differentials only when percutaneous biopsy revealed multinucleated osteocleastic giant cells. Further diagnosis was confirmed by spotted oblique radiographs and computed tomography (CT). Surgical excision with repair of the chest wall by a mesh was done. The postoperative histopathological examination of the resected specimen confirmed the preoperative diagnosis of giant cell tumour. The present article aims to aware the reader about such rare presentations of GCT, which should be included in the differential diagnosis of a tumour originating from the anterior arc of the rib.

Intrarenal post-traumatic pseudoaneurysm-USG colour Doppler diagnosis: a case report with review of literature.

Renal artery pseudoaneurysm, although a well-known complication in patients after penetrating trauma or iatrogenic injury, has rarely been described after blunt torso trauma. A 22-year-old man suffered an accident while on a motorcycle. Upon arrival in the Emergency Room, the patient was unconscious, hypotensive and had hematuria. Initial investigations revealed a fractured shaft of the right femur, multiple rib fractures with hemothorax, extradural haematoma on the right side and a laceration in the right kidney. After the evacuation of intracranial bleed, the patient was managed conservatively. The patient recovered well and was discharged on the 15th post-trauma day. The patient was again present in the emergency room after 6 weeks with 1-week history of gross hematuria. Ultrasonography revealed an anechoic lesion in the right kidney with pulsatile flow on colour Doppler. Further investigation with computed tomography renal angiography was done, which confirmed the pseudoaneurysm of a branch of renal artery. The patient was referred to a higher centre where he was successfully managed with selective arterial coil embolisation.

Mammary tuberculosis: analysis of thirty-eight patients.

Thirty-eight patients with mammary gland tuberculosis were evaluated over a 5-year period presenting to the surgical unit of our institution. Unilateral involvement of the breast in a woman presenting at an average age of 29 years was the commonest observation. A lump in the breast with or without discharging sinuses was the most common clinical presentation. Ten (26%) of these patients had breast pain with or without increased breast nodularity. Axillary lymph nodal involvement was evident in 14 (36%) of our patients. Only five patients had associated pulmonary tuberculosis, the rest having an isolated involvement of the breast. Fine-needle aspiration cytology was the most reliable diagnostic modality. Medical therapy with antitubercular drugs ranging from 6 to 9 months was the mainstay of treatment. Surgical intervention was reserved for selected refractory cases.

Sinus histiocytosis with massive lymphadenopathy.

Sinus Histiocytosis with Massive Lymphadenopathy is a very rare condition often presenting as neck swelling of unknown etiology. The disease involves extranodal sites in 20-30 percent of cases and histologically characterized by emperiopolesis, non-cohesive and non-epitheloid histocytes with abundant eosinphilic cytoplasm. An ideal treatment is yet to be established but here we present a short series of chemotherapy with alternating ABVD and COPD cycles giving satisfactory results.

Unusual presentations of foreign body in aerodigestive tract.

Foreign bodies lodged in aerodigestive tract makes the commonest emergency in the otorhinolaryngology clinics. Diagnosis often becomes difficult with parental ignorance and lack of clear history. Patients with foreign body can have unusual presentations.

Ultrasound and colour Doppler sonography in acute osteomyelitis in children.

Early diagnosis of osteomyelitis is of paramount importance to avoid irreversible sequelae. This often requires a multimodal approach. The purpose of the present study was primarily to evaluate how ultrasound might be useful in early diagnosis of osteomyelitis in the paediatric age group. The evolution of ultrasound findings with progression and resolution of disease was also analysed. In this prospective study, 55 children with osteomyelitis of limbs were subjected to sonographic examination including colour Doppler study. The sonographic machine used was a LOGIC-500, using a linear multifrequency transducer (7-9 MHz). Ultrasound guided aspiration was performed in all cases showing sub-periosteal accumulation of fluid, and the aspirate was sent for culture and sensitivity report. Surgical drainage was undertaken in all patients in which a sub-periosteal abscess was demonstrated. Anechoic fluid accumulation contiguous with bone was highly suggestive of osteomyelitis, whereas presence of soft tissue between the bone and the fluid suggested a non-osseous origin of the fluid. Sub-periosteal accumulation of fluid was seen in 42 cases (76.3%). A subperiosteal abscess with periosteal reaction was demonstrated in 35 children (63.63%). Colour Doppler study revealed increased vascular flow within or around the affected periosteum in all cases. Concurrent involvement of a joint was noted in 13 cases. Ultrasound is a rapid, cheap, easily available, non-ionising and reasonably accurate diagnostic modality. It also helps in localising the lesion for diagnostic aspiration. Serial ultrasound and technical innovations such as colour Doppler sonography further help in monitoring the progression and resolution of the disease.

Congenital macrodactyly: a clinical study.

Congenital macrodactyly is a rare congenital malformation characterised by progressive enlargement of all mesenchymal elements of a digit. The present study is an attempt to draw the attention towards the similarities and differences between macrodactyly of the hand and foot. Radiographical, operative findings and histopathological examination of five cases are included in the present study. Emphasis was given to know the possible basic lesion. Radiographic findings, which differentiate this entity from other forms of local gigantism, were also analysed. The most characteristic finding noted was excessive overgrowth of fibro-fatty tissue with unusually large fatty lobules, apparently fixed by a mesh of dense fibrous tissue. Hypertrophy and tortuosity of the digital nerve, a striking feature in macrodactyly of the hand, was notably absent in cases affecting the foot. None of the patients had any other associated congenital anomalies. Neither the patients nor any of their family members had any stigmata of neurofibromatosis. Chromosomal study was normal in all of them. We conclude that in macrodactyly of the foot, excessive proliferation and accumulation of adipose tissue was the basic lesion, whereas involvement of the nerve might be the fundamental lesion in gigantism of the hand. Furthermore, whatever be the basic lesion, the final pathway must be either the local deficiency of a growth inhibiting factor or local expression of a basic intrinsic factor, leading to excessive growth of all elements of the digit.

Synchronous germinomas in the pineal and suprasellar region.

Synchronous primary intracranial germ cell tumors are rare. Only 5-10% of all germ cell tumors are found as synchronous lesion in pineal and suprasellar region. They are also known by the entity "double mid-line atypical teratoma". An 11-year-old male child presented with polyuria, polydipsia and features of raised intracranial tension. CT scan head revealed well-defined homogenously enhancing lesions in the pineal and suprasellar region. Histopathology examination showed the lesion to be of germ cell origin.

Iniencephaly.

Iniencephaly is a rare congenital anomaly which is a type of neural tube defect. Babies with iniencephaly are almost always still born but exceptionally live born cases are reported. This article reports a case of a live born iniencephalic baby who died about 15 minutes after birth.