The Morbidity of Greater Trochanteric Pain Syndrome is Similar to that of Hip Osteoarthritis Awaiting Total Hip Arthroplasty

Background: Greater trochanteric pain syndrome (GTPS) is characterized by chronic lateral hip pain and dysfunction. While psychosocial measures of other tendinopathies have been gaining traction, GTPS is less well studied. We sought to characterize the morbidity upon presentation of GTPS and compared it to patients with end-stage, hip osteoarthritis (OA) awaiting total hip arthroplasty (THA). Methods: This study examined patient reported outcomes measures (PROMs) on activity limitations, quality of life (QOL), pain, and level of disability, in all patients with GTPS and end-stage, pre-THA hip OA. All patients presented at a single academic medical center between October 2016 to November 2020. The PROMs were analyzed using an equivalence test and two-one-sided t-tests. Results: A total of 156 patients (193 hips) with GTPS and 300 patients (326 hips) with hip OA were investigated. Equivalence in mean UCLA Activity score between GTPS and OA groups were established with tolerance margin of ± 5. The difference in mean UCLA score was 0.002 (95% CI -0.45 to 0.43, p \u3c 0.01) between GTPS and OA patients. Equivalence in mean VAS score between GTPS and OA were established with tolerance margin of ± 10. The difference in mean VAS score was 0.35 (95% CI -0.86 to 0.16, p = 0.02). HOOSQol score was much worse in GTPS patients, placed well outside of the ± 10 tolerance margin and difference in means score was 1.72 (95% Cl -2.17 to -1.26, p = 0.99). All estimated differences were comparable with and without the adjustment for each PROM respectively, suggesting the differences (or the lack of) in the PROMs between GTPS and OA couldn’t be explained by the differences in sex, age, BMI, race, ethnicity, or smoking status. Conclusion: This cumulative evidence characterizes GTPS as painful and limiting in activities of daily living, as pre-THA hip OA, and with poorer quality of life scores than hip OA. This study validates results of other studies that have investigated PROMs between GTPS and pre-THA, hip OA patients. Clinicians and researchers should not underestimate the disease, and further research on characterizing the progression of the disease should be a priority

Primary non-Hodgkin's lymphoma of breast – A rare cause of breast lump

AbstractWe, here, report a case of primary breast lymphoma in a 59years old female. The diagnosis was suspected on fine needle aspiration cytology and confirmed on excision biopsy of the tumor. Histology and immunophenotyping were in accordance with non-Hodgkin's diffuse large B-cell lymphoma. The patient has been planned for adjuvant chemoradiation. The management and outcome of primary breast lymphoma and carcinoma are totally different. Early and prompt diagnosis of primary breast lymphoma is of utmost importance to avoid unnecessary mastectomies. Fine needle aspiration cytology supplemented by immuno-cytochemistry can be applied as a reliable and cost-effective tool in the early diagnosis of primary breast lymphomas, while histopathology and immunohistochemistry are conclusive

CAM5.2 Expression in Metastatic Tumours of CNS: A Diagnostic Tool

Introduction: Secondary tumours or metastases account for more than half of all brain tumours in adults. Central nervous system is most commonly a target of metastatic dissemination. The judicious use of  selected immunostains is unquestionably helpful in diagnostically challenging cases. CAM 5.2 being highly specific, is emerging as a specific marker to diagnose metastatic carcinoma.Presentation of case: Total six metastatic tumours were studied using CAM5.2. Histopathological sections of brain tissue were stained by routine hematoxylin and eosin (HE) as per standard technique. Representative sections were subjected to immunohistochemical staining with CAM 5.2. Skin biopsy act as a positive control for cytokeratin.All of the 6 cases showed positivity for CAM 5.2. CAM5.2 expression in metastatic tumours was statistically significant (sensitivity 100% 100% specificity).Conclusion: We conclude in our study that CAM5.2 was significantly associated with metastatic tumours, as they were positive using this specific marker

Epidermal inclusion cyst of breast diagnosed on fine needle aspiration cytology: a retrospective study

Background: Epidermal inclusion cyst (EIC) is a rare benign condition of breast. Patient presents with palpable breast lump and needs to be differentiated from other breast lesions. This study included cases of epidermal inclusion cyst of breast (EICB) diagnosed on fine needle aspiration cytology (FNAC) and their correlation with histopathological findings.Methods: Study was conducted in a retrospective manner over a period of 2 years.  8 Patients who presented with breast lump and were cytologically diagnosed as EIC were included in the study. Cytological features were suggestive of EIC or infective EICB. Histopathological confirmation was done. Female: Male ratio in the study was 7:1 with an age range of 35 to 54 years. Radiological investigations favoured benign lesions in 5 cases and tubercular collection in one case.Results: FNAC was performed and May-Grunwald-Giemsa stained smears showed numerous anucleate squames and mature squamous epithelial cells in a clean or inflammatory background. Diagnosis of EICB or infective EICB was made on cytology. Diagnosis was confirmed histologically in 6 cases.Conclusions: Asymptomatic lesions do not require biopsy and treatment. Follow-up is sufficient if typical clinical and radiological findings are there. But in symptomatic cases, excision should be done followed by histopathological confirmation to rule out malignant lesion. Diagnosis should be made on FNA whenever associated with characteristic pultaceous aspirate and cytological findings.

Male breast carcinoma: study from a tertiary care centre in North India

Male breast cancer is a rare malignancy. In recent years a rise in the number of male breast cancer cases has been seen. Due to rarity of the disease the reporting of such cases is important to support the present status of this aggressive malignancy. Fine needle aspiration method for breast FNA is an invasive procedure but can provide a diagnosis without causing much morbidity to the patient. Hence, objective of the present work was to report and study the clinico-pathological behaviour of male breast cancer at a tertiary care centre in North India using fine needle aspiration-based diagnosis. Present study includes cytologically diagnosed male breast carcinoma cases over a period of 4 years. Eleven cases of male breast cancer were identified. Median age of presentation was 57years. All the eleven patients presented with main complaint of swelling in breast (100%), nine (81.8%) patients presenting in left breast and two (18.2%) in right breast. Four cases presented with nipple retraction. Also, axillary lymphadenopathy was evident in four (34.4%) patients. Male breast cancer an aggressive disease having distinct clinical presentation, can be cytologically diagnosed easily as other benign conditions are rare in male breast.

Towards a Rigorous Network of Protein-Protein Interactions of the Model Sulfate Reducer Desulfovibrio vulgaris Hildenborough

Protein–protein interactions offer an insight into cellular processes beyond what may be obtained by the quantitative functional genomics tools of proteomics and transcriptomics. The aforementioned tools have been extensively applied to study Escherichia coli and other aerobes and more recently to study the stress response behavior of Desulfovibrio vulgaris Hildenborough, a model obligate anaerobe and sulfate reducer and the subject of this study. Here we carried out affinity purification followed by mass spectrometry to reconstruct an interaction network among 12 chromosomally encoded bait and 90 prey proteins based on 134 bait-prey interactions identified to be of high confidence. Protein-protein interaction data are often plagued by the lack of adequate controls and replication analyses necessary to assess confidence in the results, including identification of potential false positives. We addressed these issues through the use of biological replication, exponentially modified protein abundance indices, results from an experimental negative control, and a statistical test to assign confidence to each putative interacting pair applicable to small interaction data studies. We discuss the biological significance of metabolic features of D. vulgaris revealed by these protein-protein interaction data and the observed protein modifications. These include the distinct role of the putative carbon monoxide-induced hydrogenase, unique electron transfer routes associated with different oxidoreductases, and the possible role of methylation in regulating sulfate reduction

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Oncocytic carcinoma of lip: A rare neoplasm of minor salivary gland

Oncocytic carcinoma is an extremely rare neoplasm of the salivary gland, with only a few cases reported in literature till date. We report the occurrence of this rare lesion in lip in a 43-year-old female presenting with a progressively increasing swelling for which excision was done. Fine needle aspiration was done and the smears revealed tumor cells with well-defined cell borders, round to oval, central to eccentrically located moderately pleomorphic nuclei with fine chromatin, prominent nucleoli and abundant eosinophilic granular cytoplasm. Microscopic examination of the resected tumor showed solid sheets, nests, islands and cords of oncocytic cells diffusely infiltrating the surrounding tissues. After 5 months, the patient again presented with bilateral submandibular and right axillary lymphadenopathy revealing metastatic deposits from oncocytic carcinoma. We report this case of oncocytic carcinoma because of its unusual location, the minor salivary gland of lip being a rare site for the tumor

Pulmonary metastases of uterine endometrial stromal sarcoma in a young patient: An extreme rarity

Endometrial stromal sarcoma (ESS) is a rare malignant tumor of the endometrium, usually seen in perimenopausal females. We report a case of ESS in a 24 year old woman, presenting as rapid enlargement of a uterine fibroid associated with irregular and excessive vaginal bleeding along with a lung nodule. Hysterectomy was performed. Histopathological examination and immunohistochemistry confirmed ESS. A proper preoperative diagnosis is difficult and in most cases the diagnosis is confirmed after hysterectomy for a presumed benign disease. Simultaneous pulmonary metastasis of ESS is an extremely rare event. As the tumor is rarely encountered, management protocols are still questionable. Although rare, ESS should be considered in the differential diagnosis of all women who present with a rapid enlargement of a uterine leiomyoma. This report is aimed to present a case of endometrial stromal tumor in a young female with simultaneous lung metastasis because of its rare existence and difficulties in establishing histological diagnosis. Keywords: Endometrial stromal sarcoma, Immunohistochemistry, Lung metastasis, Malignant uterine tumor, Uterine leiomyom