A bizarre highly vascular tumor with alarming presentation: a diagnostic dilemma

An exceedingly rare, highly vascular tumor with atypical and alarming presentation posed diagnostic and management challenges. A 29 years old lady, complained of abdominal and pelvic pain, nausea, vomiting and repeated spells of fainting attacks following the jumping episode (2-3 times). Emergency admission and investigations at United States of America (USA) revealed a large, complex, highly vascular, irregular mass displaying finger like projections, filling the lower abdomen, pelvis and large amount of intra peritoneal bleed. A provisional diagnosis of arteriovenous malformation (AVM), arteriovenous fistula (AVF), and rupture/leak was made. Uterine artery angiography (UAA), preoperative embolization and possibility of hysterectomy as a life saving measure were suggested, to which the couple declined and got discharged. To save uterus and fertility they presented to us for second opinion and further management. Angiography, magnetic resonance imaging (MRI) and preoperative uterine artery embolization were done followed by exploratory laparotomy which revealed hemoperitoneum and a large weird looking vascular tumor (a veil of sea weeds/dark purple nodules of various sizes resembling cotyledons of placenta). Intra-operative tissue analysis (frozen section) suggested benign pathology. Mass was removed completely and fertility sparing surgery was undertaken. Histopathological diagnosis was cotyledonoid dissecting leiomyoma (CDL). No recurrence/metastasis has been observed on follow up of 5 years

Coexistence of iron deficiency and thalassemia trait: a study in antenatal females

Background: Thalassemia is most common genetic disorder worldwide and about 7% of world population is carrier. The prevalence of Beta thalassemia trait (BTT) is 3.5–10% in India. The National Family Health Survey (NFHS-3) of 2011 reveals the prevalence of iron deficiency anemia (IDA) as 70–80% in children, 70% in pregnant women, and 24% in adult men. As both of them are close differential diagnosis and both can coexist together, this study aims to detect hemoglobinopathies in pregnant women and quantify the effect of iron deficiency on HbA2 levels in order to improve the detection of β thalassemia trait with and without iron deficiency.Methods: Hb, RBC indices, and peripheral smears of 90 pregnant females with microcytic hypochromic blood picture were studied. Serum ferritin and HPLC (High Performance Liquid Chromatography) was performed. The results were analysed statistically by using SPSS version 16.0.Results: 93.3% patients had HbA2 4.0% which characterise BTT and remaining 2.22% had between 3.0%-4.0%. HbA2 <2.0% may be seen in IDA, ATT, HbH disease and Delta thalassemia. 91.11% had reduced serum ferritin and 2.22% had normal ferritin levels.Conclusions: This study reveals that there is frequent occurrence of iron deficiency anaemia in patients with thalassemia traits. This can substantially invalidate the diagnosis of the latter. Hence, iron deficiency should be identified and rectified in patients with suspicion of thalassemia trait

Spectrum of Childhood and Adolescent Ovarian Tumors in India: 25 Years Experience at a Single Institution

BACKGROUND: Ovarian tumour in children and adolescent girls form an uncommon but important part of gynaecological malignancies. They account for 1% of all the childhood malignancies and 8% of all abdominal tumours in children. Since the ovarian cysts are thought to arise from mature follicles, these tumours were considered to be infrequent in the paediatric population.AIM: The rarity of this condition prompted us to conduct this study and share our experience on the incidence and clinicopathological features of different ovarian tumours in girls up to 20 years of age observed in last 25 years at a single tertiary care hospital.MATERIAL AND METHODS: This was a retrospective study conducted in the Department of Pathology at a tertiary hospital, Delhi. All ovarian tumours up to the age of 20 years in the past 25 years (1990-2014) were included for the purpose of studying the clinicopathological aspects of ovarian tumours in this age group. Descriptive statistics for prevalence and age-wise prevalence was done. Chi-square test, to find an association between the age, laterality and size with malignancy was performed.RESULTS: We received a total of 1102 cases of ovarian tumours over the period of 25 years  (1990 to 2014), of which 112 (10%) cases were seen in girls up to 20 years of age. The mean age of the patients was 15.3 ± 4 years. The most common presenting complaint was pain abdomen (46.4 %) There was a statistically significant correlation found between size and malignancy status of tumours in our study (p = 0.00). Of 112 cases of ovarian tumours, 39/112 (34.8%) were malignant and 73/112 (65.2%) were benign. Mature  cystic teratoma (27.6%) was the most common type of benign tumour in this age group and immature teratomas were the most common type of malignant ovarian neoplasms.CONCLUSION: Premenarchal girls with ovarian masses may have varied presentations. Abdominal pain is the most common presenting complaint of young adolescent girls with adnexal masses. So the index of suspicion should be kept high and prompt investigations like ultrasound must be performed early to rule out such adnexal masses. Immature Teratoma was the most common malignant and mature cystic teratoma was the most common benign tumour in our study

Lamellar body count as a predictor of neonatal respiratory distress syndrome in preterm premature rupture of membranes

Background: Lamellar bodies are present in amniotic fluid and their quantity increases with increased gestational age. Preterm premature rupture of the membranes (P-PROM) is one of the most common complications of pregnancy and is a major cause of preterm deliveries and thus the important cause of RDS. Fetal pulmonary maturity can be assessed by direct or indirect measurement of surfactant phospholipids secreted by the fetal lungs into amniotic fluid. Lamellar body count (LBC) has been introduced as an alternative to other methods.Methods: The study’s prime aim is to establish LBC as a predictor of RDS in P-PROM. We included pregnant women with P-PROM and gestational age between 28 weeks and 37 weeks and singleton live pregnancy. The lamellar body counting from amniotic fluid was done with the use of a standard hematology cell counter, sysmex KX-21. There was statistically significant co-relation between lamellar body count and period of gestation (by applying ANOVA).Results: Lamellar body counts were significantly less in cases of RDS as compared to non RDS cases.Conclusions: LBC count was selected among all other tests because the test can be performed with equipment found in most clinical analysis laboratories and is reliable in predicting fetal lung maturity

Stepwise pathogenic evolution of Mycobacterium abscessus.

Although almost all mycobacterial species are saprophytic environmental organisms, a few, such as Mycobacterium tuberculosis, have evolved to cause transmissible human infection. By analyzing the recent emergence and spread of the environmental organism M. abscessus through the global cystic fibrosis population, we have defined key, generalizable steps involved in the pathogenic evolution of mycobacteria. We show that epigenetic modifiers, acquired through horizontal gene transfer, cause saltational increases in the pathogenic potential of specific environmental clones. Allopatric parallel evolution during chronic lung infection then promotes rapid increases in virulence through mutations in a discrete gene network; these mutations enhance growth within macrophages but impair fomite survival. As a consequence, we observe constrained pathogenic evolution while person-to-person transmission remains indirect, but postulate accelerated pathogenic adaptation once direct transmission is possible, as observed for M. tuberculosis Our findings indicate how key interventions, such as early treatment and cross-infection control, might restrict the spread of existing mycobacterial pathogens and prevent new, emergent ones

Bacteria-inducing legume nodules involved in the improvement of plant growth, health and nutrition

Bacteria-inducing legume nodules are known as rhizobia and belong to the class Alphaproteobacteria and Betaproteobacteria. They promote the growth and nutrition of their respective legume hosts through atmospheric nitrogen fixation which takes place in the nodules induced in their roots or stems. In addition, rhizobia have other plant growth-promoting mechanisms, mainly solubilization of phosphate and production of indoleacetic acid, ACC deaminase and siderophores. Some of these mechanisms have been reported for strains of rhizobia which are also able to promote the growth of several nonlegumes, such as cereals, oilseeds and vegetables. Less studied are the mechanisms that have the rhizobia to promote the plant health; however, these bacteria are able to exert biocontrol of some phytopathogens and to induce the plant resistance. In this chapter, we revised the available data about the ability of the legume nodule-inducing bacteria for improving the plant growth, health and nutrition of both legumes and nonlegumes. These data showed that rhizobia meet all the requirements of sustainable agriculture to be used as bio-inoculants allowing the total or partial replacement of chemicals used for fertilization or protection of crops

THE CONTROLLED ORIENTED ATTACHMENT OF COLLOIDAL SEMICONDUCTOR NANORODS INTO GEOMETRICALLY DIVERSE NANOSTRUCTURES AND LARGE SCALE ASSEMBLIES

Ph.DDOCTOR OF PHILOSOPHY (FOS

Correlation of FOXL2 with Inhibin and Calretinin in the Diagnosis of Ovarian Sex Cord Stromal Tumors

Objective: Alpha-inhibin and calretinin have been traditionally used as immunomarkers for sex cord stromal tumors. However, the variation in their immunoreactivity and their lack of specificity for sex cord stromal tumor makes the search for a more sensitive and specific immunohistochemical marker essential in routine diagnosis of sex cord stromal tumor. This study was conducted to correlate the diagnostic utility of FOXL2 with inhibin and calretinin in the diagnosis of sex cord stromal tumors of ovary. Material and Method: The study was conducted in the department of pathology. 31 cases of sex cord tumors received in past eight years (2002-2010) were included in this study. Immunostaining for inhibin, calretinin and FOXL2 was performed and compared on the basis of staining intensity and percentage positivity on all the cases. Results: Calretinin was found to be positive in 29/31 sex cord stromal tumors with variable intensities and was negative in two cases of sex cord stromal tumors, inhibin was positive in 28/31 and only three cases had no cytoplasmic staining. All the 31 cases included in this study were positive for FOXL2 with variable staining intensities and percentage positivity. Ten cases of each surface epithelial and germ cell tumors were also negatively stained with FOXL2. Conclusion: In contrast to inhibin and calretinin, FOXL2 had a sensitivity and specificity of 100% for all the cases of sex cord stromal tumors included in this study

Intraosseous glomus tumor of distal phalanx, thumb :A rare case report

Glomus tumors are rare benign neoplasms of glomus bodies. Commonly encountered in the subungal region of digits these can be found anywhere in the body. Although some rarely encountered sites including stomach liver synovium etc. have been reported, intraosseous location of these tumors have been described in less than 25 cases in the literature. We present a case of a 60 year old female presenting with complaints of stabbing pain for past 2-3 years in the distal phalanx of the right thumb. Radiography revealed a well demarcated cystic lesion in the distal phalanx. Microscopy and immunohistochemistry were suggestive of an intraosseous glomus tumor. Since the occurrence of these tumors in the bone is very rare and there are 10% chances of recurrence and even smaller chance of malignant transformation, correct diagnosis and complete excision is essential for better prognosis of the patients