Comparative evaluation of self-pressurized Air-Q® and Proseal™ LMA® in patients undergoing elective surgery under general anaesthesia: A randomized clinical trial.

Background and Aims: Intra-cuff pressure of Air-Q self-pressurized laryngeal airways (Air-Q SP) balances airway pressure and adapts to patient's pharyngeal and periglottic structures, thus improves oropharyngeal leak pressure (OLP).This study was performed to compare efficacy of Air-Q SP with Proseal laryngeal mask airway (PLMA) in patients undergoing elective surgery. Material and Methods: The study design was prospective, randomized and controlled. Ninety patients were randomly assigned to Air-Q SP or PLMA group. All patients were premedicated and shifted to operation theatre. Monitoring was instituted. After securing IV-line, induction with inj. Morphine + Propofol, relaxation with inj. Vecuronium was done. Supraglottic was inserted according to group allocation. Outcome measures were OLP, fibreoptic view of larynx, success rate, device insertion parameters, haemodynamic and respiratory parameters and post-operative laryngopharyngeal complications. Neostigmine + glycopyrrolate were given, device was extubated. Results: All supraglottic airway devices (SADs) were successfully placed in two attempts. The mean initial OLP, OLP at 10 minutes, and device insertion time were significantly lower in Air-Q SP group. Fiber-optic laryngeal view grading was significantly better with Air-Q SP. No significant difference was observed with respect to rate of successful insertion in first attempt, ease of insertion, and manipulations required. The hemodynamic/respiratory parameters and post-operative sore throat in the two both groups were similar. Conclusions: Proseal LMA has a higher OLP than Air-Q SP but average insertion time was better, and fiber-optic grading of laryngeal view was shorter with Air-Q SP. However, Air-Q SP and Proseal LMA were both effective for lung ventilation.

Comparison of the analgesic efficacy of two different fascial blocks in patients undergoing laparoscopic inguinal hernia surgery: A randomized control trial.

Background and Aims: Moderate-to-severe intensity pain is reported on the first day following lower abdominal surgery. No study has compared transversus abdominis plane (TAP) block with retrolaminar block (RLB) in laparoscopic inguinal hernia surgery for postoperative pain relief. Material and Methods: In this prospective, randomized trial, 42 male patients of American Society of Anesthesiologists (ASA) physical status I and II, aged 18-65 years, and having a BMI <40 kg/m2 received TAP or RLB following laparoscopic inguinal hernia surgery. A standard general anesthetic technique was performed. Patients were randomized into two groups: single-shot TAP block (group I) (n = 21) or the RLB (group II) (n = 21) with bilateral 20 ml of 0.375% ropivacaine. Postoperatively, IV paracetamol 1 g was administered as rescue analgesia. Postoperative cumulative Visual Analogue Scale (VAS) score 24 hours after surgery was considered as the primary outcome. Results: Postoperative cumulative VAS score at rest at 24 h, represented as mean ± S.D (95% CI), in the TAP block group was 3.54 ± 3.04 (2.16-4.93) and in the RLB group was 6.09 ± 4.83 (3.89-8.29). P value was 0.112 and VAS on movement was 7.95 ± 3.41 (6.39-9.50 [2.5-15.0]) in TAP block group, whereas P value was 0.110 and VAS on movement was 10.83 ± 5.51 (8.32-13.34) in the RLB group. Conclusion: Similar postoperative cumulative pain score on movement at 24 h was present in patients receiving TAP block or RLB. However, VAS score at rest and on movement was reduced in patients receiving TAP block at 18 and 24 h postoperatively.

Clinicoepidemiological Observations of Enteric Fever in Infants: Experiences From a Tertiary Care Pediatric Hospital in North India.

BACKGROUND: There is a lack of evident data to explain the true scenario of age-specific enteric fever in India. The current study aimed to evaluate the burden and disease pattern of enteric fever among infants in a tertiary care pediatric hospital. METHODS: A prospective laboratory-based surveillance was conducted from April 2018 to January 2020 at a children's hospital in North India, under the Surveillance for Enteric Fever in India study. The study included children <1 year of age in whom Salmonella serovar Typhi/Salmonella serovar Paratyphi grew in cultures from blood or sterile body fluid. The key outcome measures included disease spectrum and clinical presentation. RESULTS: Of the 10 737 blood cultures from infants, 26 were positive for S. Typhi or S. Paratyphi. The majority of cases occurred in infants aged 6-12 months, with the youngest being 1 month old. Fever with abdominal pain and diarrhea were the common symptoms, with 46% of infants requiring inpatient care. All of the isolates were susceptible to ceftriaxone. Third-generation cephalosporins were used as the first-line therapy for hospitalized infants. The average duration of fever was 8.6 days. The overall case-fatality rate among infants with enteric fever was 7.4%. CONCLUSIONS: Enteric fever is a major contributor to disease and death among children. Robust surveillance studies are required to understand the true disease burden.

Cytological diagnosis of microfilariae in clinically unsuspected cases: A retrospective review of 12 cases.

BACKGROUND: Filariasis is a major health problem in India. Despite the high prevalence, microfilariae are rarely found in cytology smears. Most of the cases are incidentally found, solely or in association with other pathologies. AIMS AND OBJECTIVES: This study was undertaken to analyse the prevalence and cytological findings of cases of incidentally found microfilariae in cytology smears (fine needle aspiration cytology [FNAC]/exfoliative cytology) from different parts of the body. MATERIALS AND METHODS: This was a retrospective study over 3 years, in which cases of microfilariae in aspirates from swelling of different locations, body fluids, and pap smears were reviewed, and the clinicopathological data analysed. RESULTS AND ANALYSIS: Out of 11 530 cases of FNAC, 8700 cases of fluid cytology, and 9000 of conventional cervicovaginal smears, 12 cases (0.04%) of incidental findings of microfilariae were documented in cytology smears. The cases were diagnosed from lymph node (one case), hand (one case), scrotal area (one case), axilla (one case), breast (one case), subcutaneous tissue (three cases), urine (three cases), and Pap smear (one case). We found eosinophilia in one case (8.3%) of filarial lesions. We found two cases of incidental findings of microfilariae in association with malignant lesions. CONCLUSION: Cytology smear examination can play an important role in diagnosing occult filariasis in clinically unsuspected cases in association with other pathologies.

Cytomorphological spectrum of cysticercosis: A study of 26 cases.

BACKGROUND: Cysticercosis is a systemic parasitic disease caused by the larval stage of Taenia solium. It is the most common parasitic disease worldwide. Fine needle aspiration cytology can play an important role in prompt recognition of this disease. OBJECTIVE: To study the role of FNAC in the diagnosis of cysticercosis. MATERIALS AND METHODS: This study included 26 patients with parasitic infestation who presented with palpable subcutaneous and intramuscular nodules at different sites. Their clinical presentations and fine needle aspiration cytomorphological features are reported. RESULTS: The age range of these patients was 7-60 years. The majority were males. The most commonly affected site was head and neck followed by upper extremity. Most of the cases were clinically misdiagnosed as lipomas, neurofibromas, lymphadenitis, epidermal inclusion cyst, sialadenitis, and soft tissue tumours. The aspirate was clear fluid in the majority of cases. All of the cases revealed fragments of bladder wall with associated granulomas in seven cases and giant cells in four cases. However, none of the case revealed hooklets. CONCLUSION: Fine needle aspiration cytology can provide a simple, minimally invasive, low-cost, outpatient diagnostic technique for the diagnosis of cysticercosis, as cytological diagnosis is quite clear when the actual parasitic structures are identified in the smear.

Photoresponsive chain collapse in a flexo-rigid functional copolymer to modulate the self-healing behaviour.

Synthetic systems mimicking the natural self-folding process are attractive to impart multiple structural control over polymer crosslinking and the subsequent alteration of their macroscopic self-healing properties. In that regard, polymers P1-P5 containing pendant photo-crosslinkable moieties were designed and underwent intra- or interchain collapse to form diverse nanostructures. The shape and dimension of the nanostructures could be efficiently controlled by the concentration, solvent compatibility and characteristics of the polymers. Photodimerization of the coumarin moieties transformed the extended coiled chain of the polymer to uniform sized nanoparticles in a dilute condition, while in the crowded macromolecular concentration regime, the polymer folded into nanostructures with polydisperse topologies that were far from a condensed globule or partially swollen globule conformation. Scaling law exponents for polymer chain compaction suggested an interchain collapse with rigid compact segments connected by flexible polymer chains that draws an analogy with elastomers. Such a hardening of the rigid segment as a consequence of photodimerization rendered a significant increase in the glass transition temperature (Tg), which could be reversibly controlled upon decrosslinking. Lastly, the structural variation of this class of polymers over self-healing was explored and the crosslinked polymers showed phototriggered non-autonomic and intrinsic self-healing behaviour under ambient conditions. This is an interesting approach to access a photomodulated self-healing system with low Tg polymers that shows the coexistence of autonomic and nonautonomic self-healing pathways and that may find application in designing smart coatings for photovoltaic devices.

Evaluation of the Effects of Fluoride Prophylactic Agents on Mechanical Properties of Nickel Titanium Wires using Scanning Electron Microscope.

INTRODUCTION: Orthodontic treatment these days is increasing in demand, and therefore, it is relatively imperative for the orthodontist to prescribe the use of fluoride-containing products, such as mouthwashes and gels, to help prevent dental caries and maintain healthy oral health. The aim of the study was to assess and evaluate the effects of fluoride prophylactic agents on mechanical properties of nickel titanium (NiTi) wires during orthodontic treatment using scanning electron microscope (SEM). MATERIALS AND METHODS: We used the commercially available round preformed NiTi orthodontic archwire (3M company) and three different mouthwash solutions, i.e., Phos-Flur gel (1.1% sodium acidulated phosphate fluoride, APF, 0.5% w/v fluoride, pH = 5.1; Colgate Oral Pharmaceuticals) and Prevident 5000 (1.1% sodium fluoride neutral agent, 0.5% w/v fluoride, pH = 7; Colgate Oral Pharmaceuticals). All the specimens were subjected to a three-point bending test on a universal testing machine. To observe the surface morphological changes, one wire from each group was randomly selected and observed under a SEM. RESULTS: It was observed that there was not much difference in the values of both modulus of elasticity and yield strength obtained after loading of stress on the wires in all the three experimental conditions. A significant difference in both modulus of elasticity and yield strength was observed during unloading of stress. Further, when the surface characteristics were observed for all the specimens using SEM images, it was observed that NiTi wires treated with Phos-Flur showed large surface defects which appeared as round, pitted areas depicting corrosion, numerous white inclusions, and overall damaged surface structure of the wire as compared with the control. CONCLUSION: Thus, fluoridated mouthwashes are essential to maintain good oral hygiene and decrease instance of caries in patients undergoing orthodontic treatment. The prophylactic usage of topical fluoride agents on NiTi wire seems to diminish the mechanical properties of the orthodontic wire that could significantly affect future treatment outcomes. CLINICAL SIGNIFICANCE: It has been proved that fluoride mouthwashes/gels do affect the structural surface qualities and strength of wires used during the orthodontic treatment irrespective of the composition of the wires. Therefore, it is the responsibility of the clinician to prescribe these prophylactic agents carefully while keeping in mind their pH so that the overall result of the treatment may not be hampered and delayed due to change in properties of the wires used.

Physical shearing imparts biological activity to DNA and ability to transmit itself horizontally across species and kingdom boundaries.

BACKGROUND: We have recently reported that cell-free DNA (cfDNA) fragments derived from dying cells that circulate in blood are biologically active molecules and can readily enter into healthy cells to activate DNA damage and apoptotic responses in the recipients. However, DNA is not conventionally known to spontaneously enter into cells or to have any intrinsic biological activity. We hypothesized that cellular entry and acquisition of biological properties are functions of the size of DNA. RESULTS: To test this hypothesis, we generated small DNA fragments by sonicating high molecular weight DNA (HMW DNA) to mimic circulating cfDNA. Sonication of HMW DNA isolated from cancerous and non-cancerous human cells, bacteria and plant generated fragments 300-3000 bp in size which are similar to that reported for circulating cfDNA. We show here that while HMW DNAs were incapable of entering into cells, sonicated DNA (sDNA) from different sources could do so indiscriminately without heed to species or kingdom boundaries. Thus, sDNA from human cells and those from bacteria and plant could enter into nuclei of mouse cells and sDNA from human, bacterial and plant sources could spontaneously enter into bacteria. The intracellular sDNA associated themselves with host cell chromosomes and integrated into their genomes. Furthermore, sDNA, but not HMW DNA, from all four sources could phosphorylate H2AX and activate the pro-inflammatory transcription factor NFκB in mouse cells, indicating that sDNAs had acquired biological activities. CONCLUSIONS: Our results show that small fragments of DNA from different sources can indiscriminately enter into other cells across species and kingdom boundaries to integrate into their genomes and activate biological processes. This raises the possibility that fragmented DNA that are generated following organismal cell-death may have evolutionary implications by acting as mobile genetic elements that are involved in horizontal gene transfer.

Inhibition of enteroaggregative Escherichia coli cell adhesion in-vitro by designed peptides.

Enteroaggregative Escherichia coli (EAEC) bears remarkable capacity to adhere the host intestinal mucosal surface and results in acute or persistent childhood diarrhea worldwide. In this study, an attempt has been made to inhibit EAEC cell adherence in-vitro using synthetic peptides. E. coli isolates (n = 54) were isolated from the stool samples of clinically diagnosed pediatric diarrheal patients. 92.8% isolates showed different types of aggregative adherence patterns with HEp-2 cells. AAF-II (Aggregative Adherence Fimbriae-II) EAEC exhibited the maximum ability to form biofilm and intracellular survival. Peptides were designed against the high antigenic epitopic regions of AAF-II adhesin of EAEC O42 using prediction algorithms like BcePred and ProPred software to block the EAEC cell adhesion in-vitro. Peptides P2 (DITITPATNRDVNV) and P3 (MRIKAWGEANHGQL) demonstrated higher inhibition of EAEC cell adhesion than P1 (GMQGSITPAIPLRPG). Interestingly, increasing the pre-incubation time of the peptides with HEp-2 cells from 1 h to 2 h showed the maximum inhibition. The data suggested the potential role of P2 and P3 peptides in successfully blocking the binding of AAF-II EAEC with HEp-2 cell receptors. Hence, the peptides may be efficacious in designing new chemotherapeutic for the management of EAEC mediated diarrhea.

Clathrin-mediated hemoglobin endocytosis is essential for survival of Leishmania.

Leishmania is auxotroph for heme. Previously, we have shown that Leishmania acquire heme from the degradation of endocytosed hemoglobin via a specific receptor located in the flagellar pocket. Here, we report the cloning and expression of clathrin heavy chain from Leishmania (Ld-CHC) and provide evidences that Ld-CHC is localized in flagellar pocket and regulates Hb-endocytosis in Leishmania. Kinetic analysis of Hb trafficking in GFP-Ld-CHC overexpressed Leishmania reveals that Hb is internalized through Ld-CHC coated region and remains associated with Ld-CHC containing vesicles at early time points of internalization and subsequently starts dissociating from Hb-containing vesicles at later time points indicating that clathrin-coating and uncoating regulate Hb trafficking in Leishmania. Interestingly, overexpression of dominant negative mutant of clathrin heavy chain of Leishmania (GFP-Ld-CHC-Hub) blocks the Hb internalization and causes severe growth defect in parasite. Moreover, we have shown that chlorpromazine, a pharmacological agent, blocks Hb internalization in Leishmania by depolymerizing Ld-CHC and thereby inhibits the growth of the parasites. Taken together, our results have shown that Hb endocytosis in Leishmania is a clathrin dependent process and is essential for the survival of the parasites.

Acute panmylelosis with myelofibrosis - A rare case report with review of literature.

ABSTRACT: Acute panmyelosis with myelofibrosis (APMF) corresponds to <1% cases of acute myeloid leukemia, which could be an underestimation due to missed diagnosis. Due to its rapidly fatal course, it warrants a timely and correct diagnosis. We present a case of a 44-year male who came with a short history of fever, generalised weakness, revealed pancytopenia with occasional circulating blast in the peripheral blood smear. Bone marrow aspirate was dry tap,biopsy revealed panmyelosis with myelofibrosis with increased (22%) blasts. Flowcytometric immunophenotyping, cytogenetics and molecular tests were undertaken. Together with clinical details, immunophenotypic profile, cytogenetics and molecular studies, the diagnosis of Acute panmyelosis with myelofibrosis was made and managed accordingly. 32 The WHO 2017 describes APMF as an acute panmyeloid proliferation with increased blasts (≥20% in the bone marrow or peripheral blood) and accompanying marrow fibrosis. APMF is rare with poor prognosis thus, must be differentiated especially from Acute megakaryoblastic leukemia to arrive at the correct diagnosis which will help reduce/prevent the early mortality by providing timely chemotherapy followed by upfront hemopoietic stem cell transplantation.

Case of angioimmunoblastic T-cell lymphoma presenting as peripheral and bone marrow plasmacytosis: A diagnostic conundrum.

ABSTRACT: Angioimmunoblastic T-cell lymphoma (AITL), a subtype of peripheral T-cell lymphoma (PTCL), is associated with unique clinical, morphological, and immunohistochemical features. The peripheral circulation might show presence of an occasional reactive plasma cell but significant plasmacytosis masquerading as plasma cell leukemia is rare. We report a case of AITL in a 42-year-old male, who presented with two-month history of generalized lymphadenopathy. On investigations, he had hypergammaglobulinemia and plasmacytosis in the peripheral blood and bone marrow masquerading as plasma cell leukemia. Immunohistochemistry and serum protein electrophoresis revealed polyclonal nature of plasma cells. Diagnosis of AITL was made on cervical lymph node biopsy. This case highlights the diagnostic challenge faced due to heterogeneity in the clinical presentation and pathological findings and to alert the clinician so that timely accurate diagnosis can be made to initiate the treatment.

Assessment of the phenotypic severity of hemophilia A: using rotational thromboelastometry (ROTEM) and APTT-clot waveform analysis.

BACKGROUND: Hemophilia A (HA) is an X-linked inherited bleeding disorder caused by reduced factor VIII (FVIII) levels. Approximately 10-15% of patients with severe HA (SHA) do not present with the anticipated bleeding pattern. Here, we assessed the phenotypic severity of hemophilia A using rotational thromboelastometry (ROTEM) and activated partial thromboplastin time-clot waveform analysis (APTT-CWA). METHODS: Patients diagnosed with hemophilia A were enrolled. Clinical phenotype assignment was performed according to the published literature, and patients were classified into four phenotypic subgroups. The whole blood sample was first run on ROTEM in INTEM mode using platelet-poor plasma, APTT was run, and the APTT-CWA graph was simultaneously recorded. RESULTS: A total of 66 patients were recruited for this study. Statistically significant differences were observed between the four phenotypically categorized groups using ROTEM and APTT-CWA. On comparing patients with mild/moderate-to-severe phenotypes (Group II) with SHA without inhibitors (Group IV), no significant difference was found for all parameters of ROTEM or APTT-CWA. The MCF, MA30, MAXV, and Alpha angle values using ROTEM were found to be the lowest in patients with SHA with inhibitors, which helped differentiate them from those with SHA without inhibitors. However, these two groups could not be differentiated using the APTT-CWA parameters. CONCLUSION: ROTEM can be used to distinguish patients with SHA with inhibitors from those with SHA without inhibitors using a combination of parameters with high sensitivity and specificity. However, APTT-CWA cannot be used to differentiate these patient groups.

Stimuli-Responsive Self-Assembly Disassembly in Peptide Amphiphiles to Endow Block-co-Fibers and Tunable Piezoelectric Response.

Supramolecular assemblies with well-defined structural attenuation toward varied functional implications are an emerging area in mimicking natural biomaterials. In that regard, the redox stimuli-responsive ferrocene moiety can reversibly change between a nonpolar ferrocenyl and polar ferrocenium cation that endows interesting modular features to the building blocks with respect to self-assembly/disassembly. We design a series of ferrocene anchored peptide fragment NVFFAKKC using hydrophobic alkyl spacers of different chain lengths. Increasing the spacer length between the redox-responsive and self-assembling motifs increases the propensity to form robust nanofibers, which can be physically cross-linked to form hydrogels. The controlled redox response of the ferrocene moiety tandem with pH control provides access to structural control over the peptide nanostructures and tunable mechanical strengths. Further, such redox-sequestered dormant states hinder the spontaneous nucleation process that we exploit toward seeded supramolecular polymerization to form block cofibers composed of redox-responsive periphery and nonresponsive cores. Finally, such redox sequestration of peptide self-assembly renders an on-off piezoelectric response for potential utilization in peptide bioelectronics.

Pelvic Synovial Sarcoma Clinically Masquerading as an Ovarian Malignancy.

Background: Synovial sarcoma, a malignant mesenchymal tumor, commonly involves the extremities and is rarely found in the pelvis. Cytology with a biphasic pattern can suggest the diagnosis of synovial sarcoma. Case Report: A 32-year-old female presented with complaints of abdominal distension. She was initially evaluated in another hospital where she underwent ultrasound-guided fine needle aspiration cytology (FNAC) of the abdominal mass. The mass was diagnosed as ovarian adenocarcinoma, and the patient underwent 3 cycles of chemotherapy. After 3 months, she was referred to our institute for surgical excision of the mass. Contrast-enhanced computed tomography of the abdomen suggested a well-circumscribed, heterogeneous, solid-cystic mass in the left adnexal region measuring 13.9 × 10 × 9.1 cm and compressing the adjacent structures. No previous radiologic investigations were available. We reviewed the FNAC slide from the outside hospital and made a preliminary diagnosis of biphasic synovial sarcoma. The patient underwent debulking surgery consisting of panhysterectomy with excision of the pelvic mass. Microscopic examination of the pelvic mass showed a biphasic tumor composed of epithelial and mesenchymal components, suggestive of synovial sarcoma. The immunohistochemistry profile supported the morphologic diagnosis. Bilateral ovaries were unremarkable. The patient received 4 cycles of adjuvant chemotherapy and is presently asymptomatic. Conclusion: Although primary pelvic synovial sarcoma is a rare occurrence, this case illustrates that synovial sarcoma can be diagnosed or at least suspected on FNAC. Because of the importance of adjuvant chemotherapy, synovial sarcoma must be high on the list of differential diagnoses of high-grade intra-abdominal masses.

The efficacy of ultrasound-guided triple nerve block (ilioinguinal, iliohypogastric, and genitofemoral) versus unilateral subarachnoid block for inguinal hernia surgery in adults: a randomized controlled trial.

INTRODUCTION: The present study was carried out to evaluate the efficacy of ultrasound-guided triple nerve block (ilioinguinal, iliohypogastric, and genitofemoral) versus unilateral subarachnoid block for adult male patients undergoing unilateral inguinal hernia surgery. MATERIAL AND METHODS: Sixty ASA I-III adult male patients > 18 years old, scheduled for unilateral inguinal hernia surgery were randomly allocated into 2 groups of 30 patients each. In Group A ( n = 30) the patients received ultrasound-guided nerve block (ilioinguinal, iliohypogastric, and genitofemoral), and in Group B ( n = 30) the patients received unilateral subarachnoid block. The primary outcome was to assess postoperative analgesic efficacy (visual analogue scale [VAS] scores at rest and during coughing/ambulation). The secondary outcomes were time to first rescue analgesia with morphine, the total dose of morphine used as rescue analgesia, urinary retention, time to first micturition, time to first unassisted walking, and time to discharge from the surgical recovery room. RESULTS: The mean pain scores at 1, 2, 4, and 6 hours during rest and during coughing/ambulation were significantly lower in Group A when compared to patients in Group B ( P < 0.001). There was no requirement for rescue analgesic opioids in Group A ( P < 0.001). Mean time to first micturition and mobilization occurred earlier in Group A, leading to early discharge from the recovery room ( P < 0.001). No major side effects were observed in any of the study groups. CONCLUSIONS: Ultrasound-guided triple nerve block technique can be used as a sole anaesthetic technique for inguinal hernia surgery because it not only provides optimal anaesthesia intra-operatively but also has a favourable analgesic and opioid-sparing efficacy in the early postoperative period with minimal adverse effects.

ALK-positive anaplastic large cell lymphoma of skeletal muscle masquerading as soft tissue sarcoma.

Anaplastic large cell lymphoma (ALCL) is a subtype of T cell non-Hodgkin's lymphoma and can present as an extranodal disease. Primary ALCL of skeletal muscle is rare. We report a case of ALK-positive ALCL involving the left thigh and anterior chest wall in a 12-year-old male child. The fine needle aspiration cytology from the lesion showed cellular smears with singly scattered and occasional clusters of large pleomorphic atypical cells. A diagnosis of poorly differentiated malignant neoplasm was rendered. On core biopsy, the histomorphological features posed a diagnostic challenge with a myriad of morphological mimickers. The diagnosis was established by excluding specific entities by relevant immunostains and confirming the diagnosis by strong expression of CD30 and ALK on immunohistochemistry. Fluorescence in-situ hybridisation confirmed the characteristic t(2:5) translocation. Presentation of ALCL with skeletal muscle involvement is uncommon, and the diagnosis relies on broadening the diagnostic possibilities and judicious use of immunohistochemical markers.

Adenosquamous Carcinoma of the Extrahepatic Bile Duct.

Background: Most malignant tumors arising from the biliary tract are adenocarcinomas. Adenosquamous carcinoma is an uncommon variant of extrahepatic bile duct cancer that is associated with more aggressive behavior than adenocarcinoma. Case Report: A 58-year-old male presented with complaints of obstructive jaundice and dull aching pain in the abdomen. At his initial evaluation in another hospital, ultrasound of the abdomen and magnetic resonance cholangiopancreatography revealed common bile duct dilatation with an ill-defined lesion in the periampullary region. Endoscopic retrograde cholangiopancreatography showed infiltration of the ampulla. Biopsy specimen taken during stenting of the common bile duct suggested dysplasia. Because of recurrent jaundice, the patient was referred to our institution, and contrast-enhanced computed tomography (CT) of the abdomen showed a hypoenhancing lesion with ill-defined margins in the head of the pancreas. The patient underwent a Whipple procedure. Microscopic examination of the pancreaticoduodenectomy specimen showed an invasive adenosquamous tumor arising from the distal part of the common bile duct that infiltrated the body and head of the pancreas, involved the wall of the duodenum, and reached the duodenal mucosa. Morphologic diagnosis was supported by immunohistochemistry profile. Postoperative contrast-enhanced CT of the abdomen showed multiple enlarged mesenteric lymph nodes and multiple lesions in both lobes of the liver, suggestive of metastasis. The patient died 1 week after surgery. Conclusion: Because the clinical, pathologic, and prognostic characteristics of adenosquamous carcinoma are poorly known, early diagnosis of this rare entity is warranted for patient management.