Not just skin deep: Multiple cutaneous nodules as first presenting sign of small cell cancer.

A 65 years old male, chronic smoker (30 pack years), presented with complaints of dyspnea (mMRC grade2), cough (dry in nature), loss of appetite, loss of weight ( > 5 kgs), weakness, bony pains, feverish feeling and easy fatigability for last 2-3 months.Contrast enhanced CT chest showed bilateral extensive paraseptal and centriacinar emphysematous changes, right upper lobe spiculated heterogeneously enhancing soft tissue lesion and significant conglomerate mediastinal lymphadenopathy encasing lower trachea and great vessels.As patient was high risk for development of pneumothorax related to image guided sampling of right upper lobe lesion in view of extensive emphysema; patient was referred to us for EBUS-TBNA (endobronchial ultrasound guided transbronchial needle aspiration) guided mediastinal lymph nodes sampling. But on head to toe examination revealed round, firm, non-tender, skin coloured, 2-3 cm size skin nodules (2 on left lateral chest wall, 1 on right lateral chest wall and 1 in proximity to umbilicus).Fine needle aspiration cytology (FNAC) was attempted from two of skin nodules which was suggestive of small cell lung cancerSkin metastasis as initial presentation is reported rarely in small cell lung cancer.The index case emphasize on importance of detailed physical examination in cases of lung cancer to look for any skin manifestation of the disease, although encountered rarely.Moreover detection of skin nodules helps in staging and prognosis of diseases.

Epithelial inclusion cyst of the cecum: A rare entity.

Epithelial inclusion cyst of the cecum (EICC) or epidermoid cyst of the cecum is extremely rare. Only seven cases of EICC have been reported in the English literature until now. A case of EICC is being reported in a 25-year-old female who presented with a pelvic mass associated with lower abdominal pain radiating to back. Abdominal contrast-enhanced computed tomography scan showed a well-defined mass juxtaposed to cecum. During operation, a subserosal cystic mass was found adherent to the anterior wall of the cecum and confirmed to be an epithelial inclusion cyst histopathologically. It is being reported due to its extreme rarity.

Pure primary signet ring cell carcinoma breast: A rare cytological diagnosis.

Signet ring cell carcinoma (SRCC) of the breast is a rare tumor and it is classified by World Health Organization in 2003 classification under 'mucin producing carcinomas'. Pure form of SRCC breast is an extremely rare entity and very few cases have been reported in literature so far. We present a case of pure primary SRCC of the breast in a 70-year-old female, which was diagnosed on fine needle aspiration cytology. Cytological features generally show cellular smears with tumor cells showing eccentrically placed large, irregular nuclei showing indentations at places with cytoplasmic vacuoles. This case is being presented in view of its characteristic cytological features and its rarity.

Cytological diagnosis of Castleman's disease of the soft tissue.

Castleman's disease (CD), a rare benign disease is characterized by lymphoid hyperplasia of uncertain etiology that may present as a nodal or extranodal mass. We describe herein a rare case of CD occurring in the soft-tissue of right arm in a 55-year-old woman. The present case is instructive in the differential diagnosis of primary soft-tissue tumors, for which the possibility of CD should be considered. On clinical examination as well as gross examination, this disease mimics lymphomas and tuberculosis. Since cytological appearances vary depending on the type and extent of hyperplasia, fine needle aspiration cytology findings may not always be conclusive in all cases. We studied aspirates which revealed reactive hyperplasia with increased vascularity. Excision confirmed the diagnosis.

A rare case of primary fibrosarcoma of kidney.

Primary sarcomas of kidney are rare tumors accounting for 1% to 3% of all primary renal malignancies. Among sarcomas fibrosarcoma is rare. Here we report a case of primary fibrosarcoma of the kidney in a 70-year-old man who presented with gradually increasing abdominal swelling and pain.

Human trichinosis in remotes of Uttarakhand, India.

Trichinosis is a parasitic zoonosis caused by ingestion of infected meat containing larvae of Trichinella, more prevalent in developing countries. Although infection with Trichinella is globally distributed, it has been documented only rarely in India. The reports are available where Trichinella larvae were found from animals in India but, to our knowledge, only one human case has been reported from India (Punjab), so far. This is the first report of small multiple outbreaks of human trichinosis in India (2009-2011). Epidemiological, clinical, and laboratory findings of trichinosis patients belonging to remote areas of Uttarakhand were analyzed retrospectively and prospectively. Patients belonged to remote areas of Garhwal, Uttarakhand, 77.78% were male, and 22.22% were female. The age of patients ranged from 9-55 yrs. History of eating meat of wild boar was given by all (100%). The signs and symptoms of the patients varied even after intake of same diet, and included generalized weakness/malaise, myalgia, fever, gastrointestinal symptoms, facial/periorbital edema, subconjunctival hemorrhages, retinal hemorrhages, muscle atrophy, and dyspnea. Laboratory investigations revealed eosinophilia, leukocytosis, creatine phosphokinase (CPK) and serum glutamic oxaloacetic transaminase (SGOT) elevation in 100%, 88.89%, 50% and 16.67%, respectively. Muscle biopsies revealed larvae in 27.78%. One patient expired while others improved. The prevalence of trichinosis is likely to be underestimated. The aim of this study is to emphasize on the magnitude of the problem, to educate people, especially in the affected areas about this health hazard and help implementation of epidemiological studies and preventive measures.