EP.TH.729Spontaneous Complete Regression of Sacroma: A Case Report And Review of Literature

Spontaneous complete regression (SR) of cancer is complete or partial disappearance of the cancer without any treatment which is very rare(1). Case Report 58 year old female, with a palpable right breast lump from the chest wall at 7o clock position. It was 25mm in size, axillae demonstrated no LAD. Imaging was performed which showed a suspicious lesion with malignant features,core biopsy done. It showed pleomorphic spindled and epitheloid cells. Immunohistochemistry was negative for AE1/AE3,MNF116,CK19,CK7,P63,CK14,CK5/6 was diagnosed as sarcoma with a possibility of phyllodes tumour. Plan was made in MDT to discuss in regional sarcoma meeting and staging CT which was normal. Sarcoma MDT recommended surgery, planned for wide local excision. On the day of surgery patient came for wire localisation, however no tumor noted on imaging and patient also confirmed the same. Patient had CT and MRI which revealed no abnormalities. This was discussed in local and central MDT, advised imaging after 3 and 6 months. Discussion Spontaneous regression of breast sarcoma in Pub med yielded no cases. This process has not been clearly explained yet. Several mechanisms have been suggested for spontaneous regression, including immune modulation, withdrawal of carcinogens, infection, apoptosis, antiangiogenic and maturation mechanisms gene therapy, vaccine-mediated mechanisms among many. Conclusion This is the first case of SA of primary breast sarcoma to our knowledge and our main aim to present this case is due to its rarity.

EXPECT THE UNEXPECTED: JEJUNAL GASTROINTESTINAL TUMOUR MIMICKING OVARIAN MALIGNANCY- A CASE REPORT WITH REVIEW OF LITERATURE

Gastrointestinal stromal tumours (GISTs) are mesenchymal tumours of alimentary tract comprising 0.2% of gastrointestinal tumors and only 0.04% of small intestinal tumours. Jejunal GISTs are one of the rarest subtypes. GISTs display various morphological forms like spindle and epitheloid cells in a variety of patterns and can be submucosal, intramuscular or subserosal in location. Grossly they are solid and cyst with variable hemorrhage and necrosis. Most of the gastrointestinal stromal tumors have mutations in either KIT (CD117) or PDGFRα gene. DOG 1 is a sensitive and specic marker of GIST independent of CD117 or PGDFRα expression. Here we present a case of malignant jejunal GIST with missed diagnosis on CECT abdomen.

CHANGES IN THE MUCOSA OF THE UTERINE POD IN CANCER OF THE VAGINAL PART AND CERVIX

Changes in the mucous membrane of the body of the uterus, accompanying cancer of the vaginal part and cervix, drew special attention after the work of Abel (see No. I), which appeared in 1888. The author studied the mucous membrane of the body of the uterus, taken from extirpated cases of 6 uterus for carcinoma portionis and in 1 case for carcinoma cervicis. "In all cases, the mucous membrane is dull," says the author (p. 279, 1. p.), To a high degree of alteration, while the mucous membrane of the cervix is ​​relatively insignificantly diseased. " These changes, as can be seen from the description of each individual case, concern both the gland and the intermediate tissue, and the first in all cases were multiplied and represented corkscrew gyrus; some of them were enlarged or contained ectases of the lateral walls and processes protruding into the lumen of the gland. Changes in the intermediate tissue in cases 1, 2 and 4 consisted in the multiplication of cells in deep layers, and here they had a short-spindle-shaped shape, small size and went in trains in different directions; in the surface layers, they were more or less round, much larger in size and resembled epitheloid cells. In addition, a nested infiltration with small, round cells (lymphoid cells?) Met in places. In the remaining 4 cases, the changes in the intermediate tissue, according to the author's description, were the same as usually in chronic inflammation (cases 5, 6 and 7) or almost absent (case 3). On the basis of these studies, the author comes to the conclusion that changes in the mucous membrane of the body of the uterus in cancer of the vaginal part and cervix have the character of sarcomatous degeneration, which in observed 1, 2 and 4-m, already reached a rather high degree of 4, in the rest, although it did not appear as sharp as especially in the first case, but nevertheless, these changes, according to the author, cannot be considered as inflammatory, but should be taken only as a more weak degree of the same sarcomatous degeneration, by analogy with the first.

Isolated Gastro-Duodenal Tuberculosis Mimics Peptic Ulcer Disease in a Young Female

Intestinal tuberculosis (TB) most commonly affects ileo-caecal region. Isolated gastric and duodenal involvement without pulmonary infection is rare. The presentation of these patients varies. Patients may present with haematemesis, non-healing chronic ulcer, mimicking malignancy, gastric perforation and gastric outlet obstruction. High degree of suspicion is needed for early diagnosis of gastro-duodenal TB. A young female patient who was being treated as a case of nonhealing chronic ulcer was referred for treatment. Histopathological examination of endoscopic biopsy specimen of the patient showed presence of granulomas composed of epitheloid cells and Langhan’s giant cells with caseation with no evidence of tuberculosis at pulmonary or other body sites. After anti-tubercular chemotherapy there was resolution of symptoms and healing of ulcers. This case of isolated gastro-duodenal TB is reported for its rarity. J Enam Med Col 2019; 9(3): 189-192

A case of giant lupus vulgaris

Lupus vulgaris, the commonest form of tuberculosis of the skin, presents with a plaque that enlarges slowly with advancing edges while showing atrophy at other areas. It may be acquired by the blood stream, via lymph, by contiguous spread or from external inoculation. We describe a case of lupus vulgaris with a large erythematous-scaly plaque of 44 × 26 cm over the back and a similar 7 × 5 cm plaque over the right thigh. The plaque over the back was gradually progressive for the previous ten years and showed scarring and atrophy at places. Histopathology of the area showed caseating granulomas with Langhans giant cells, epitheloid cells and lymphocytes. A diagnosis of lupus vulgaris was made. This case is being presented owing to the large size of the lesion.

Tuberculosis of the Thyroid

Objectives: To present a case of thyroid tuberculosis and to discuss its clinical presentation, differential diagnoses and management. Methods: Design: Case Report Setting: Tertiary Government Hospital Patient: One Results: A 55-year-old farmer presented with an 8-month progressively enlarging anterior neck mass, and fine needle aspiration biopsy yielded grossly turbid straw-colored aspirate admixed with blood with microscopy showing scattered inflammatory cells and macrophages set against a colloid background. After total thyroidectomy, hispathology revealed parenchymal infiltration by multiple aggregates of plump spindled to epitheloid cells forming granulomas with interspersed multinucleated giant cells, central caseation necrosis and surrounding fibrosis with chronic inflammatory infiltrates. The nodal masses also showed prominent germinal centers with interspersed epitheloid cells and foamy macrophages. Final diagnosis was chronic granulomatous inflammation consistent with tuberculosis. Conclusion: Tuberculosis (TB) of the thyroid is a rare occurrence that can present as inflammation, infection or tumor formation of the thyroid gland. Diagnosis depends on identification of the tubercle from tissues and aspirates by acid fast staining and TB culture. Treatment consists of multiple drug therapy for tuberculosis but thyroidectomy may be an option if the thyroid gland is severely diseased. Keywords: tuberculosis, endocrine; thyroid disease

Тhe value of transbronchial needle aspiration cytology in the diagnosis of stage I and II sarcoidosis

Background/Aim. Sarcoidosis is a multisystem infmammatory disease of unknown etiology, with the lungs and intrathoracic lymph nodes the most commonly involved. The aim of this study was to assess the contribution of conventional transbronchial needle aspiration (TBNA) cytology in the diagnosis of sarcoidosis presenting as mediastinal/hilar lymphadenopathy. Methods. In this retrospective study, 58 patients with suspicion of stage I and II sarcoidosis underwent first flexibile, and then, a rigid bronhoscopy, during which TBNA of mediastinal or hilar lumph node with a 19 gauge (G) needle was done. Material from the needle was put on glass slide and prepared for the cytological and histopathological examination. Results. Out of 58 patients submitted to TBNA of mediastinal or hilar lymph nodes, adequate material for cytological diagnostics was obtained in 53 (91.37%). Out of 53 adequate cytological samples, in 38 (71.69%) noncaseous granulomatous inflammation (NGI) was found, while in corresponding histopathological samples, NGI was found in 48 (90.56%), which was significantly higher (p < 0.05). Of cytological smears, out of the cell types typical for granulomatous inflammation, in 26 (63.15%) patients the clusters of the epitheloid cells were found, in 8 (21.05%) there were both, clusters of epitheloid cells and giant multinuclear hystiocytes, and in 6 (15.76%) only single scattered epitheloid cells or small clusters of several epitheloid cells were found. The sensitivity of TBNA cytology in our group of patients with sarcoidosis was 76%, specificity 100% and accuracy 77.34%. Conclusion. TBNA is an efficient and safe procedure in the diagnosis of sarcoidosis, minimally invasive and with a little risk of complications. Using 19 G needle enables obtaining material for histological and cytological analyses, as well which contribute to the sensitivity of diagnosting sarcoidosis. The value of this type of diagnostics depends on qualification and experience both of bronchoscopist and cytologist/pathologist, as well, of the interpreter of such a material.

Oral Cellular Neurothekeoma

Cellular neurothekeoma is known as a cutaneous tumor with uncertain histogenesis. Very little involvement of mucosal membrane has been reported in the literature so far. This is a case report of an intraoral lesion in a 15-years-old girl. Histopathologic evaluation showed a tumor-consists of spindle to epitheloid cells forming micronodules in a concentric whorled shape pattern. Tumor cells were positive for CD63, vimentin, and NKI-C3. Total excision was performed and no recurrence happened after 16-month followup.

Cutaneous melanomas in rabbits: rare but often fatal

An adult male dwarf rabbit (<em>Oryctolagus cuniculus</em>) was presented to the veterinarian due to hind limb lameness. The rabbit was in a reduced body condition. Clinical examination and cytology identified a cutaneous melanoma in the inguinal region. Whole body radiographs identified multifocal radio-opaque masses in both lungs which where assumed to be lung metastases. The animal was euthanized due to the poor prognosis. Necropsy confirmed a malignant, melanotic melanoma with pulmonary and hepatic metastases. Histopathologically, the primary tumor and the metastases were composed of epitheloid cells which showed infiltrative growth. The rabbit was diagnosed with metastatic, cutaneous, melanotic melanoma. Melanomas in rabbits can be recognized as highly malignant independent on their pigmentation status. Pulmonary tropism seems to be a distinct feature of this tumor type in rabbits and indicates that a comprehensive diagnostic workup is necessary to avoid anesthesia-related incidents.

EARLY MUSCLE AFFECTION IN CHURG–STRAUSS SYNDROME

Purpose: Skeletal muscle affection already in the eosinophilic stage of Churg–Strauss syndrome (CSS) is unusual. Case report: In a 36-year-old woman with a history of recurrent bronchial infections since childhood, recurrent poly-sinusitis and nasal polyps, and bronchial asthma, easy fatigability, weakness of the lower arms and lower legs, generalized myalgias with predominance of the lower arms, recurrent vertigo and falls developed. There was recurrently elevated creatine-kinase, glutamate-oxalate-transaminase, aldolase, lactate-dehydrogenase, eosinophilic granulocyte-count, thrombocyte-count, cholesterol, and blood sedimentation rate. Histologically polyps showed diffuse infiltrations of eosinophils exclusively. Muscle biopsy revealed grouped atrophic fibers, necrotic fibers, rarely regenerating fibers, epitheloid cells and rarely perimysial eosinophilic granulozytes. According to established criteria, CSS was diagnosed. Conclusions: This case shows that affection of the skeletal muscle in CSS, may manifest as easy fatigability, myalgias, and recurrently elevated CK, and that skeletal muscle involvement may be a dominant feature not only of the vasculitic but also of the eosinophilic stage of CSS.