Small intestine strictures in opium addicts: An unrecognized cause of intestinal obstruction.

Strictures of the small intestine have been attributed many causes of Crohn's disease, nonsteroidal anti-inflammatory drugs, neoplastic, post-surgical, and corrosive ingestion. Opium as a cause of small intestine strictures has not been described. Six cases of opium addicts diagnosed with small intestine strictures were selected after excluding the possible etiology of strictures. Investigations like upper gastrointestinal endoscopy, colonoscopy (in patients with small intestinal obstruction), barium meal follow-through, and histopathology of strictures were done in all patients. Among the six cases, two patients were diagnosed with small intestinal obstruction and four patients with gastric outlet obstruction. Histopathology of the strictures revealed marked thickening of submucosa with infiltration by lymphocytes, plasma cells, and plenty of eosinophils. There was dilatation of vessels and lymphatics. The granulomatous reaction was not seen. These histological features are suggestive of concentric fibrous thickening in submucosa with stricture formation possibly as a result of drug abuse like opioids and opioid-like products resulting in transient ischemia of the small intestine leading to fibrosis. Patients were managed by surgery and deaddiction treatment was given to prevent further complications. Opium and opioid-like drugs can cause small intestinal strictures causing ulceration and fibrosis in opioid-dependent patients.

Botryoid rhabdomyosarcoma of prostate--a case report.

Botryoid rhabdomyosarcoma of the prostate is a rare tumour in children, mostly below 6 years of age. A case of 5 year old male child presenting with acute retention of urine due to botryoid rhabdomyosarcoma of the prostate is described.

Leiomyoma of urinary bladder--a case report.

A case of leiomyoma of the urinary bladder in a 35-year old female is reported on account of its rarity. The tumor was responsible for urinary compliants which disappeared after the neoplasm was excised.

Sclerosing hemangioma of the lung.

An extremely rare case of sclerosing hemangioma lung is described in a patient who presented as right sided pleural effusion with recurrence.

Spontaneous expulsion of schwannoma of epiglottis.

A rare case of spontaneous expulsion of schwannoma of epiglottis is being reported. These are neurogenic tumours arising from the schwan sheath of peripheral, cranial and sympathetic nerves. The great majority of these neurogenic tumours originate from aryepiglottic fold or false vocal cords. However the neurofibroma of the epiglottis are quite uncommon.

Argyrophilic nucleolar organizer regions in soft tissue tumors.

Argyrophilic nucleolar organizer region (AgNOR) staining was employed on 51 apparently normal representative soft tissues, 53 benign soft tissues tumors and 52 malignant soft tissue tumors with an aim to study the sensitivity and specificity of method in differentiating between the benign and malignant soft tissue tumors. The mean AgNORs count in apparently normal fibrous tissue was 1.02, whereas it was 0.94 in adipose tissue, 1.14 in smooth muscle tissue, 1.115 in skeletal muscle tissue, 1.025 in blood vessels endothelial lining cells and 1.04 in nerve tissue. The mean AgNOR count was found to be higher in benign soft tissue tumors as compared to respective apparently normal soft tissue and was found to be statistically significant. The mean AgNOR count in soft tissue sarcomas was found to be higher as compared to both apparently normal soft tissue and benign soft tissue tumors. An increase AgNOR score in both benign and malignant soft tissue tumors as compared to apparently normal soft tissue indicates high proliferative activity. The neurofibrosarcoma showed low AgNOR count as compared to other soft tissues sarcomas. The fibrohistiocytic sarcoma, leiomyosarcoma and angiosarcoma showed a mean AgNOR score of 4 or more than four. The mean AgNOR score was found to increase with high grade of the tumor. The AgNOR staining is simple and useful method in estimating tumor cell proliferation thereby differentiating normal soft tissue from non-neoplastic proliferative growth, benign and malignant soft tissue tumors. It may help in differentiating fibromatosis from fibrosarcoma, dermatofibrosarcoma protuberans of low grade malignancy from high grade malignant fibrous histiocytoma and benign hemangiopericytoma from malignant hemangiopericytoma.

Evaluation of cryostat frozen section in the diagnosis of surgical biopsies.

Cryostat frozen section technique was used on 1300 surgical biopsies. On final paraffin sections diagnosis there were 270 benign neoplasms, 200 malignant neoplasms and 830 inflammatory and non-neoplastic lesions. The overall accuracy using frozen section was 98.48 per cent with one false positive result (0.07 per cent), 17 false negative results (1.3 per cent) and 2 deferred diagnosis (0.15 per cent).

Serum immunoglobulins in leukaemia and malignant lymphoma.

The serum immunoglobulin levels were studied in 25 healthy control subjects and 23 cases of leukaemia (6 cases of acute lymphatic leukaemia, 5 cases of acute myeloid leukaemia, 2 cases of chronic lymphatic leukaemia and 10 cases of chronic myeloid leukaemia) and 17 cases of malignant lymphoma (13 cases of Hodgkin's lymphoma and 4 cases of non-Hodgkin lymphoma). The mean levels of IgG, IgA and IgM in 25 control subjects were 1573.56 +/- 91.45 mg/dl, 209.64 +/- 12.55 mg/dl and 109.81 +/- 10.03 mg/dl respectively, those in 23 cases of leukaemia were 1338.23 +/- 109.74 mg/dl, 195.53 +/- 20.72 mg/dl and 127.47 +/- 13.29 mg/dl respectively and those in 17 cases of malignant lymphoma were 996.99 +/- 99.50 mg/dl, 147.47 +/- 19.61 mg/dl and 129.35 +/- 19.95 mg/dl respectively. The mean levels of IgG and IgA were found to be decreased in cases of leukaemia with elevated levels of IgM, however, it was found to be insignificant (p less than 0.4). The mean IgG, IgA and IgM levels were found to be almost identical in different leukaemia irrespective of cytological types except in 2 cases of chronic lymphatic leukaemia which showed low levels of IgG and IgA. The mean levels of IgG and IgA were found to be significantly decreased in malignant lymphoma (p less than 0.02). IgM levels were found to be increased in 3 cases of non-Hodgkin lymphoma.

The role of imprint cytology in diagnosis of various bone and joint diseases.

Using imprint cytodiagnosis on 63 cases of bone and joint lesions, there was only one false negative result, with ten unsatisfactory smear preparations giving an overall accuracy of 82.25 per cent. Imprint cytodiagnosis is simple, cheap, rapid easy to perform and interpret because of its better cytomorphological evaluation. The accuracy rate is high when used in conjunction with various cytochemical stains.

Xanthogranulomatous cholecystitis (XGC): a clinicopathological study of 21 cases.

Xanthogranulomatous Cholecystitis (XGC) is an uncommon inflammatory disease. In a retrospective analysis of 159 cholecystectomy specimens revealed 21 cases of diffuse and focal XGC with an overall incidence of 13.2 per cent. The age distribution was identical to those of traditional chronic cholecystitis with female predominance (M:F ratio 1:4). Gallstones were seen in 15 cases with marked thickening of the gall bladder on ultrasonography. In one case it falsely diagnosed as carcinoma on ultrasonographic examination, however, histopathologically it was turned out to be XGC. One case of XGC was associated with adenocarcinoma of gall bladder. The incidence of diffuse XGC was 5.66 per cent, whereas incidence of focal XGC was 7.54 per cent amongst chronic cholecystitis.

Glycosylated haemoglobin(HbA1C) and serum protein bound hexose in diabetes mellitus.

Glycosylated haemoglobin (HbA1C) and serum protein bound hexose (SPBH) levels were estimated in 35 healthy control subjects and 35 diabetic subjects. The mean levels of SPBH in control subjects was 161.69 +/- 3.84 mg/dl. The SPBH levels in diabetic subjects were found to be increased (P less than 0.001). It was not influenced by age and sex of the patients, complications, type of diabetes and treatment received. HbA1C levels in control subjects were 5.33 +/- 0.38/dl. The HbA1C levels in diabetic subjects was found to be markedly elevated (11.95 +/- 0.46/dl) and was found to be highly significant (P less than 0.001). The levels were found to be on higher side in juvenile diabetics. A progressive linear correlation was observed between fasting blood sugar levels and concentration of SPBH and glycosylated haemoglobin concentration. A significant correlation was also observed between the levels of glycosylated haemoglobin and SPBH levels (P less than 0.05).

Extrauterine mixed mesodermal tumour of ovary with heterologous element.

The ovary is very rare site of mixed mesodermal tumour. The present case occurred in postmenopausal woman aged 52 years, in right ovary with endometrioid carcinomatous component admixed with chondrosarcomatous component and squamous element. The patient was disease free at one year follow up, with no evidence of local recurrence and distant metastases and was treated post-operatively with combination therapy of radiotherapy and chemotherapy. The review of literature is discussed briefly, with its histogenesis and its differential diagnosis from immature teratoma, malignant teratoma, sertoli leydig cell tumour containing islands of cartilages and embryonal carcinoma of ovary.

Serum glycoproteins in pulmonary tuberculosis.

Serum glycoprotein levels were studied in 50 patients of pulmonary tuberculosis and 25 healthy controls. Ten of the tuberculosis patients had stage I disease, 24 stage II, 9 stage III and 7 had pulmonary tuberculosis with effusion. The serum levels of protein bound hexose, protein bound hexosamine, protein bound fucose and protein bound sialic acid were significantly higher (P less than 0.001) in patients with pulmonary tuberculosis as compared to controls; the mean values being 195.6, 189.1, 16.3 and 120.8 mg/dl respectively in patients and 117.0, 84.1, 7.7 and 67.2 mg/dl respectively in controls. The levels were not influenced by age and sex of the subjects in both groups. The levels were found to increase in all the stages of pulmonary tuberculosis with a marginal difference. Treatment with antituberculosis drugs resulted in a decrease in ESR and the various fractions of serum glycoproteins at subsequent follow up, however, the mean levels did not reach those of control subjects and were not influenced by the type of therapy.

Neoplasms of Hair Follicle.

The present paper deals with clinico-pathological analysis of 22 cases of hair follicle neoplasm, representing 23.4% of skin appendage tumours. The mean age was 32 years, M : F ratio was 1:1. Histopathologically, there were 15 cases of pilomatrixoma, 5 cases of trichoepithelioma and 2 cases of trichelemmoma.

Basal Cell Epithelioma (A Clinico-pathological Study of 172 Cases).

The present paper deals with a clinico-pathological analysis of 172 cases of basal cell epithelioma representing 28% of the total skin cancer case. 1.44% of the total malignant tumours, 1% of the total tumours and 0.24% of the hospital admissions. M:F ratio was 1.26:1. The mean age was 54.06 years with the maximum number of cases in the fifth decade., Most (94%) of the lesions were seen on the head and neck region. Histopathologically it showed solid (60.5%), adenoid cystic (15,7%), keratotic (9.3%), pigmented (6.4%), basi-squamous (3.5%) and morphoea patterns (2.3%). Perineural lymphatic invasion was seen in 52% of the adenoid cystic basal call epithelioma. Amyloid (12.8%) and amyloid like deposits (29.65%) were seen in 42% of the case. Amyloid deposits were seen as lichen amyloidosis in 10.46% cases and in or around the tumour cell masses in 16.8% cases. It appeared as structureless homogeneous eosinophilic material and showed congophilia with apple green birefringence on polarising microscopy. It was found to be KMN04 sensitive (AA type protein- secondary amyloidosis). Amyloid like deposits appeared as less homogeneous,, basophilic, fractured material which showed non-specific congophilia with apple- green birefringence and stained with acid orcein stain indicating degenerated collagen (elastoid-degeneration).

Neoplasms of Sweat Gland.

Fifty cases of sweat gland tumours seen during a. period of 27 years, accounted for 54.34% of skin appendages tumours. There were 47 sweat glands, tumours and 3 malignant, seen in the 21- 40 years age group. M : F ratio was 1:1 Histopathol4caUy, there were 13 cases of eccrine, acrospiroma, 11 cases each of syringocystadenovaa papiuiferum and chondroid syringoma, 5 cases of eccrine, spiradenoma, 3 cases of dermal cylindrom and 2 cases each of hidradenoma papilliferum and eccrine pogrom. Three cases of malignant sweat gland tumours included 2 cases of sweat gland-carcinoma and 1 case of primary mucmous carcinomas of skin.

Primary Mucinous Carcinoma of Skin.

A 65 year old male had recurrent primary mucinous carcinoma of skin arising in the upper one third of the left forearm. It was characterised by the presence of a large area , of mucin with the tumour cells present in sheets and arranged in duct-like structures. Primary mucinous carcinoma is characterised by a very low incidence of metastases. The mucinous material seen in the primary mucinous carcinoma is non - reactive to alcian blue and aldehyde fuchsin at a very low pH (0.4).