A 45-year-old male presented with a rare pineal region cavernoma. Magnetic resonance (MR) imaging confirmed the preoperative diagnosis. The tumor was totally excised. The patient was subsequently cured. Analysis of 15 reported cases found a slight female preponderance. The second and third decades were the most common age group. The course of pineal cavernomas can be complicated by hemorrhage, occlusion of cerebrospinal fluid pathways, and focal neurological and neuroendocrine symptoms but no specific clinical features. However, MR imaging has high sensitivity and the specificity for the diagnosis of pineal cavernoma. Total microneurosurgical excision is the treatment of choice, and patients had an excellent outcome. Stereotactic biopsy can be potentially dangerous because of the risk of hemorrhage. The use of radiosurgery requires evaluation of long-term risks and safe dose levels. Total excision of the pineal cavernoma using microsurgical techniques is the choice of treatment in young and healthy patients since there is an increased risk of recurrent hemorrhage and progressive neurological decline. A conservative approach is preferred in older patients.
Sweat gland tumours are extremely rare in the eyelids. We report a case of a clear cell hidradenoma (nodular hidradenoma) in an elderly female, who had presented with a nodular swelling in a eyelid. Clear cell hidradenomas arise as intradermal nodules from eccrine sweat glands. Ultrastructural and enzyme histochemical studies have shown nodular hidradenomas to be intermediate between eccrine poroma and eccrine spiradenoma. No apocrine differentiation has ever been observed in these tumours. Malignant forms are distinctly unusual. This case is being documented for the extremely uncommon presentation of this tumour as an eyelid mass. Complete primary excision is advocated and local steroid preparations should bot be used.
Necrotizing enterocolitis is an acute disease that primarily affects premature neonates of low birth weight, and has a very high morbidity and mortality. The incidence in adults is significantly less, with lower mortality rates. Of those who survive, many are left with complications related to short gut syndrome. We report 4 cases of necrotizing enterocolitis all of whom underwent early surgical intervention and had good recovery, followed by a review of the literature on the subject.
761 Background: The incidence of estrogen receptor negative (ER negative) invasive breast carcinoma is reported to be as high as 67.6% in India, as compared to 30–33% in the western literature. It is not clear whether the high incidence among Indians is due to genetic differences between the two populations (“true ER negative status”), or an artefact (“false ER negative status”) from the use of suboptimal manual immunohistochemistry techniques. Accurate ER estimation is critical as patients with false ER negative tumors are often denied the benefits of hormonal therapy. Methods: We used automated immunohistochemistry to re-evaluate the ER status in 246 Indian patients with invasive breast carcinomas previously reported as ER negative by manual immunohistochemistry. Tumour blocks used for this study were the same that were used for the manual assay. The automated technique utilized different reagents (all US FDA approved for diagnostic immunohistochemistry) and staining protocols from those used in the manual assays. The “Quick” score method of assessment was used to assess the range of immunostaining. Results: Of the 246 previously ER negative tumors, 99 (40.24%) were found to be ER positive, and 147 (59.76%) tumors remained ER negative (Quick Score 0). Thirty-four of these 99 ER positive tumors (34.3%) had Quick Scores of 6 and 7 (“strong ER expression”) and 55 (55.55%) had Quick Scores between 1 and 5 (“moderate and low ER expression”). Conclusions: Our results indicate that the high incidence of ER negative breast cancer reported from India is most likely due to the use of suboptimal manual assays, rather than true genetic differences. ER expression in breast cancer among Indian women may be much higher than previously believed. Plausible reasons for increased sensitivity in ER detection in the current study include methods of antigen retrieval, differences in reagents, and automation. Optimal antigen retrieval could be the most critical reason for improved detection. Optimal immunohistochemical demonstration of ER is of critical importance. Patients with false ER negative tumours are denied hormonal therapy. Hormonal therapy is more suited in cost and management than chemotherapy in a limited resource country like India No significant financial relationships to disclose.
Serial plasma prolactin levels were measured in 144 breast cancer patients (premenopausal [PR-M], N = 64; postmenopausal [PO-M], N = 80) and compared with respective controls. Patients with breast cancer were grouped into those who (1) developed distant metastasis, (2) developed local recurrence, (3) stable disease, and (4) responded to the various therapeutic modalities at the end of 2 years. The authors' analysis showed excellent correlation between serial plasma prolactin changes and the response to therapy or progression of disease in patients with advanced breast carcinoma.
Pneumocystis carinii pneumonia (PCP) is believed to be rare in the developing world and no large prospective Indian series have been reported to date. The present study was conducted to study the clinical profile and outcome of PCP in patients with HIV infection.All HIV positive patients with PCP admitted over 4 years (2000-2003) to a tertiary referral centre in Mumbai were prospectively studied.There were 38 patients with proven PCP from 300 HIV admissions. The patients with PCP were predominantly male (M: F = 5.4:1), with a mean age of 40.1 years. The median CD4 count of the PCP group was 96 cells/microL. Bronchoscopy was needed to make a definitive diagnosis in 17 of the 38 patients. PCP co-existed with tuberculosis in 4 of the 38 patients. The mortality of the group was high at 15.8% with all patients needing ventilatory support dying.PCP is not an uncommon infection in Indians with advanced HIV. Lack of recognition has probably been responsible for the absence of any large series from this country. In our series of hospitalised HIV positive patients, PCP was the second commonest pulmonary disease after tuberculosis accounting for 32% of pulmonary admissions and 13 % of all HIV positive admissions.
Cryptococcosis can be a life-threatening mycosis in immunocompromised patients. However, it has a somewhat better prognosis in immunocompetent hosts. AIDS has led to an increase in the incidence of the disease. Clinically, the lesions can be confused easily with malignancy.A 25-year-old, asymptomatic male presented for a routine health check-up. The chest radiograph showed a subpleural left apical area of consolidation, suspicious for either a neoplasm or infection. Fine needle aspiration cytology (FNAC) revealed a granulomatous lesion with refractile yeast forms of Cryptococcus, both within the multinucleate giant cells and extracellularly. This was subsequently confirmed by culture and histology.The cytomorphology of cryptococcosis is characteristic, and FNAC is a useful modality for diagnosing the infection in asymptomatic patients but needs a high index of suspicion, especially in nonimmunocompromised patients.
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