Background: Schistosomiasis is an infection caused by blood flukes of the genus Schistosoma. Schistosomes are successful parasites, apparently as a result of prolonged co-evolution with their hosts. Studies done nationwide in Egypt found the highest risk of hepatitis C virus (HCV) co-infection is in those infested with schistosome without history of blood transfusions. However, the association between schistosomiasis and HCV infection is incompletely understood. Aims: The overall aim of this study was to assess whether or not a genomic association between schistosomal infestation and HCV infection exists. Materials and Methods: Oligonucleotide specific primers of HCV-polymerase chain reaction (PCR) diagnostics were used to screen the genomic DNA and cDNA library pool of Schistosoma mansoni as templates based on the end-point PCR approach. Results: Screening of schistosome DNA by PCR, lead to the detection of sequences similar to HCV. PCR products were obtained when adult worms genomic DNA were used as templates while no PCR products were amplified from S. mansoni λZAPII cDNA library pool. The resulting PCR products were sequenced and compared with the other closely related HCV sequence database at the website < http://hcv.lanl.gov>. Conclusions: This work demonstrates the existence of HCV and its replication in the genomic DNA of S. mansoni. In addition, it highlights the fact that the parasite can carry the virus genome and therefore, is considered as a nonhuman vector for the transmission of HCV infections.

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Background: Lichen planus (LP) is chronic, mucocutaneous, autoimmune disease which can affect oral mucosa, skin, scalp, nails, and genital mucosa. The prevalence of oral LP (OLP) varies with different geographic distribution. It presents symmetrical and bilateral or multiple lesions with varying clinical types accompanying with burning sensation and sometimes pain. Due to its potentially malignant nature, the evaluation of cell proliferation brings important information regarding diagnosis and prognosis of several types of cancer. Materials and Methods: Sixty-four cases of OLP were retrieved and were histologically assessed under 10× and 40× magnifications for valuation of the dysplastic features. The grading was done by the criteria followed by Odukoya et al. The data obtained were tabulated and subjected for the statistical analysis. Results: Epithelial dysplasias were observed in 60 cases of OLP which Grade I had 9 cases, Grade II 27 and Grade III 24 cases. Four cases of OLP did not show any dysplasia. The interrater reliability was found to be in strong or substantial agreement in assessing few of the dysplastic features. Male:female ratio was 1.2:1 with buccal mucosa being the most common site. Conclusion: Our study showed the importance to establish a correct diagnosis of OLP based on the history, clinical presentations, and histopathology. Furthermore, the long-term follow-up of the patient with OLP is mandatory when dysplasia is encountered on histopathology.

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Ewing sarcoma (EWS) is a rare malignant round cell tumor. It is the second common primary tumor of the bone found in children. The most common site in which it occurs is in the pelvis, the femur, the humerus, and the ribs. Due to its morphological overlap, there is diagnostic difficulty and for accurate diagnosis, requires special studies such as immunohistochemistry, electron microscopy, and molecular genetic analysis. We report a case of EWS in a 19 years boy who presented with pain and tenderness of left thigh. Fine-needle aspiration cytology was done and reported as Malignant round cell tumor suggestive of EWS. Diagnosis of EWS was confirmed with special stains and immunohistochemistry.

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Background: Trace elements (TEs) are required for physiological functioning and alterations are noted in potentially malignant disorders and oral cancer. These TEs are used in early diagnosis, treatment and also as an indicator of disease progress and prognosis. Aims: To estimate the TEs such as copper (Cu), zinc (Zn), iron (Fe), manganese (Mn) and Cu/Zn ratio in the saliva of oral submucous fibrosis (OSF) patients and controls. Settings and Design: The hospital-based study was conducted to estimate salivary TEs using atomic absorption spectrometry (AAS) in 60 individuals. Methods and Material: 5 ml saliva was collected from OSF cases (n=30) and controls (n=30) and was centrifuged and prepared by using the Wet Ashing method. The TEs were estimated in parts per million (ppm) by using AAS. Statistical Analysis Used: The data obtained was statistically analyzed using non parametric tests such as Mann Whitney U and Kruskal Wallis tests. Results: Significant difference in the mean salivary Zn, Mn and Fe levels in OSF when compared to that of controls. Mean salivary Cu levels were increased and Cu/ Zn ratio was decreased in OSF when compared to the controls. Conclusions: To conclude TEs play a role in the pathogenesis and progression of OSF. Betel quid and areca nut chewing habits are frequently associated with OSF and alters the salivary TE levels. Concerted efforts would, therefore, help in early detection, management and monitoring the efficacy of treatment.

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Background: The excessive consumption of tobacco in Southeast Asia especially in India has prompted us to undertake this retrospective study. Aims and Objective: The aim was to assess the prevalence of head and neck (HN) and oral cancer (OC) in Rajasthan State, India. Methods: A retrospective study on the prevalence of various cancers in the HN and oral cavity regions was conducted in the Department of Oncology, S.M.S Hospital, Jaipur, from 1 ^st August 2013 to 31 ^st July 2014. Results: A total of 4587 total body malignancy cases were reported for the out-patient department records, among which HN and OC constituted 1476 cases (32.18%). There were 640 (43.36%) and 836 (56.64%) HN, and OC cases, respectively. Conclusions: This study attempts to quantify and analyze the spectrum of HN and OC in the region. A comprehensive effort is needed to identify the cause of such high prevalence, generate awareness, adopting preventive measures and treatment modalities suited to meet this challenge.

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Cutaneous metastasis from underlying visceral malignancies is a rare phenomenon. Rarely, cutaneous metastasis can be the first manifestation of an underlying malignancy. Cutaneous metastases, in most patients, usually reveal a terminal stage of illness. Hence, in such cases, it is crucial to use a minimally invasive technique for either the diagnosis or exclusion of metastasis. Fine needle aspiration cytology can be used as an alternative to biopsies, as this is a minimally-invasive, relatively simple, rapid and inexpensive procedure. The site of primary may remain unknown in some cases, as was seen in our case.

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Osteoid osteoma is a benign bony tumor characterized by presence of a nidus of osteoid vascular bone with dense sclerotic bone in its periphery. Osteoid osteomas comprises 10% of all benign bone tumors and 1% of all spinal tumors, with lumbar spine (60%) as the most common site, followed by cervical (27%) and thoracic spine (12%). A spinal osteoid oesteoma usually present as back pain localized around level of lesion. We reported a case of osteoid osteoma involving the dorsal spine in 13-year-old boy who presented with progressive backache for last 6 months. Spine is an uncommon site for this benign tumor, and these patients are usually symptomatically treated for nonspecific back pain. Magnetic resonance imaging is useful investigation but computed tomography scan appears as better investigation modality to study the extent, size and location of the osteoid osteoma in the spine. Most patients require direct surgical excision, curettage or percutaneous radiofrequency ablation to remove the lesion.

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Rhabdomyosarcoma (RMS) is one of the most frequent soft tissue sarcomas. Pure testicular RMS is a very rare tumor and a few cases have been reported in the literature. We report a 16-year-old male patient with a painless right testicular swelling who underwent high inguinal orchiectomy and diagnosed as testicular embryonal RMS. The patient had a rare recurrence at the scrotal site with inguinal and retroperitoneal metastasis.

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The Warthin-like variant of papillary thyroid carcinoma (PTC) is a recently described, uncommon variant of PTC. Proper identification of this variant is warranted as it shows good clinical behavior when compared with other oncocytic rich neoplasms of the thyroid. We present a case of Warthin-like variant of PTC in a 40-year-old female patient and describe the clinicopathological features, along with the differential diagnosis of this rare tumor.

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Background: To study the diagnostic pitfalls in fine needle aspiration cytology (FNAC) of salivary gland lesions and role of cytokeratin 7 (CK7) and 20 in differentiating various salivary gland neoplasms as an adjunct. Materials and Methods: This study included 230 cases of salivary gland lesions, which underwent FNAC at our hospital, and cyto-histological correlation was possible in 119 cases. False positive and false negative cases were identified taking histology as the gold standard and discrepant results were analyzed. Additionally, immunohistochemical staining for CK7 and 20 was done in 35 representative histological sections (including 33 malignancies and 2 benign lesions). Results: On cytology, benign tumors and nonneoplastic lesions together formed 63% and remaining 37% were malignancies. Cyto-histological correlation showed concordance rate of 80.6% and discordance rate of 19.3% with 14 false negative cases and 9 false positive cases. On immunostaining for CK, 27 of the total 33 malignancies (81.8%) exhibited CK7+/CK20 − profile. All the primary malignancies (24/25) except one were CK7+/CK20−, while majority of the secondary malignancies (5/8, 62.5%) showed CK7−/CK20 − profile. Conclusion: Although the diagnosis of most salivary gland neoplasms does not pose a problem, attention to subtle cytomorphological features and knowledge of common diagnostic pitfalls are essential to reach the correct diagnosis in a few challenging cases. Additionally, CK expression can serve as a useful adjunct to other investigations in cases of salivary gland neoplasms, to differentiate between certain commonly confused entities like, squamous cell carcinoma and high-grade mucoepidermoid carcinoma; and CK20 positive metastatic malignancy and distant unknown primary.

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Hodgkin lymphoma (HL) primarily presents as nodal disease and may involve extranodal sites during the progression of the disease. Extra nodal involvement of lung, gastrointestinal tract, testis and thyroid etc., is well-recognized in non-HL but clinically detectable soft tissue involvement is rare and quite exceptional with HL. We report here an unusual case of a young adult male, who presented with a frontal soft tissue mass associated with cervical lymph node. Histopathology supplemented with immunohistochemistry revealed classical HL. Patient did not respond to treatment adequately, and he developed intracranial metastasis during the course of treatment.

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Hodgkin's lymphoma with sternal involvement at presentation is quite unusual. Owing to its rarity, it often poses vexing diagnostic challenges. We herein bring into focus a case of advanced stage Hodgkin's lymphoma, presenting with a sternal mass, initially misdiagnosed and treated as Langerhans cell histiocytosis. On subsequent follow-up, the patient developed recurrence and repeat biopsy and imaging suggested Hodgkin's lymphoma. The case report highlights the importance of clinical suspicion of unusual presentation of lymphohematopoietic tumors of the bone.

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Background : Poly(I:C) is a Toll-like receptors 3 agonist, which induces potent innate immune responses, and as a consequence adaptive immunity. However, the rapid degradation of poly(I:C) influences its half-life and its adjuvant effects in preclinical and clinical uses. Aims : We aimed in this study to conjugate poly(I:C) with polyethylene glycol/poly D, L-actide-co-glycolide (PLGA/PEG) polymers as an approach for better delivery and immunomodulatory effects. Materials and Methods : Female CD1 mice were treated once with PEG/PLGA, poly(I:C)/PLGA/PEG (50 μg), poly(I:C)/ PLGA/PEG (10 μg) or PEG via intraperitoneal injection and mice were sacrificed 1 day later for complete blood count analysis and analysis of the immune cells by flow cytometry. Results : Treatment with PEG/PLGA, poly(I:C)/PLGA/PEG (50 μg), poly(I:C)/PLGA/PEG (10 μg) or PEG administration resulted in significant (P = 0.0197) increases (1.89, 1.76, 1.69, and 1.42-fold, respectively) in the absolute number of neutrophils as compared to naïve mice. Conclusion : Conjugation of poly(I:C) with polymers does not hamper its immunomodulatory effects, instead it enhances its effects on increasing the number of immune cells opening an avenue for further studies on the beneficial effects of this conjugate.

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Sebaceous gland carcinoma commonly arises in the periocular area and is an uncommon condition. Its orbital origin is even rare with isolated reports in literature search. Its early diagnosis is frequently missed owing to the subtle presentation that mimics various benign conditions. Surgery with wide resection margin is considered the standard of care. Irradiation is frequently indicated and administered as an adjuvant regimen following surgical resection. The role of chemotherapy in this disease remains investigational and is usually employed in recurrent settings.

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Squamous cell carcinoma (SCC) with osteoclast-like giant cells (OLGCs) is a rare entity known to occur in skin, breast, lung, and pharynx. Only a single case of SCC containing OLGC in larynx has been reported so far. We report a case of a 65-year-old male patient presenting with sudden onset respiratory distress, who was subjected to biopsy, which was reported as undifferentiated sarcoma which was endorsed on laryngectomy specimen, however, sections from cervical lymph nodes revealed deposits of SCC. Extensive resectioning revealed a single focus showing origin of poorly differentiated carcinoma from the overlying squamous epithelium. Hence in undifferentiated pleomorphic sarcoma, a thorough sectioning and careful search for SCC including immunohistochemical markers should be done to exclude the possibility of a poorly differentiated epithelial malignancy.

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Background: To assess perception of selected risk factors for cancer and heart attack among visitors of a public hospital. Materials and Methods: Randomly 1651 ambulatory adults were contacted using predesigned, pretested, semi-structure interview schedule comprising selective 12 risk factors for cancer (increasing age, tobacco, obesity, alcohol, diet-rich in fat/oil, diet-poor in fruits and vegetables (F and V), physical in-activity, environmental pollution, multiple sexual partners, insecticides/pesticides/chemicals, micro-organism, family history) and 11 for heart attack (increasing age, tobacco, obesity, alcohol, diet-rich in fat/oil, diet-poor in F and V, physical in-activity, hypertension, diabetes mellitus, mental stress, family history). Correct response was awarded one mark and incorrect/do not know response as zero. Results: The study participants comprised of 56.2% attendants and 43.8% patients with mean age of 36.78 (±13.05) years; 71.2% were male, 65% resided in rural area and 32.3% subjects were smoker. A statistically (P = 0.001) higher odds for smoking was found among less educated (odds ratio [OR]: 1.30), rural (OR: 1.60), male (OR: 2.85), patients (OR: 1.41) of more than 30 years of age (OR: 1.67). Nearly, 64.5% and 82.0% subject responded that tobacco causes the heart attack and cancer while obesity was considered as a risk factor by 68.4% (heart attack) and 28.1% (cancer). Nearly, 70.7% and 32.0% reported diet rich in fat/oil and poor in F and V could lead to heart attack but only 23.5% and 25.8% mentioned respectively for cancer. Mean risk factors identified for heart attack were 6.64 ± 2.29 (range: 0-11) while for cancer it was 5.01 ± 2.33 (range: 0-12). Nearly, 670 (40.58%) and 620 (37.55%) subjects mentioned spontaneously at least one type/anatomical site-specific cancer of male and female respectively; 73.4% believed that cancer does not spread by social activity and 54.2% opined that cancer is treatable if detected early. Conclusion: Overall low to moderate level of awareness was noticed for selected risk factors of heart attack but still better than cancer with ample scope for capacity building of stakeholders.

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Primary thyroid lymphomas (PTLs) constitute only 1-2% of all extranodal lymphomas and approximately 2-8% of all thyroid malignancies. Thyroid non-Hodgkin lymphoma (NHL), though not common, is curable without the need for extensive surgery. Fine-needle aspiration cytology (FNAC) has become the procedure of choice for the initial diagnosis of thyroid nodule, but there are very few reports of FNAC of PTL in the literature. Most common thyroid lymphomas are diffuse, large, B-cell lymphoma (DLBCL), and mucosa-associated lymphoid tissue lymphoma (MALT). When dealing with DLBCL, the main cytological differential diagnosis to be kept in mind is anaplastic thyroid carcinoma. Differentiating these entities is required at the cytological level as both require different treatments, in fact, DLBCL can be treated by chemotherapy while anaplastic thyroid carcinoma by surgical excision. Diagnosis of MALT, which is a low-grade NHL is difficult on FNAC as it closely resembles Hashimoto thyroiditis (HT). We report herein a case of 52-year-old female, suffering from HT since 10 years, who developed a thyroidal DLBCL. This case emphasizes the role of FNAC as a good diagnostic tool that, followed by Tru-cut biopsy for accurate PTL typing, can avoid the morbidity associated with surgery.

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Hemangiomas are benign vascular lesion, most commonly seen in liver and skin whereas rarely found in genitourinary system. Urethral hemangiomas are mostly found in males. To the best of our knowledge, in females only handful of case reports has been described in the literature. We report a case of urethral hemangioma in a 28-year-old female presented with history of intermittent hematuria. Cystourethroscopy examination revealed vascular mass of 2 cm Χ 2 cm at anterior urethral meatus. Surgical excision of mass with fulguration of base with diathermy was performed under general anesthesia. Final diagnosis on histopathology was given as cavernous type of urethral hemangioma. In spite of its benign nature, these lesions have a tendency to recur. In more extensive lesions or recurrence, open exploration with resection of involved tissue is always needed. Treatment of hemangiomas depends on size and site of the lesion and follow-up is needed to avoid recurrence. Histomorphological diagnosis of the lesion is always warranted in view of different treatment modalities.

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Background: Skin cancer is the most frequent neoplasia in the world. Even though ultraviolet radiation is the main cause, established prevention campaigns have not proved to be effective for controlling the incidence of this disease. Objective: To develop clinical prediction rules based on medical consultation and a questionnaire to estimate the risk of developing nonmelanoma skin cancer. Methods: This study was developed in several steps. They were: Identifying risk factors that could be possible predictors of nonmelanoma skin cancer; their clinical validation; developing a prediction rule using logistic regression; and collecting information from 962 patients in a case and control design (481 cases and 481 controls). We developed independent prediction rules for basal cell and squamous cell carcinomas. Finally, we evaluated reliability for each of the variables. Results: The variables that made up the final prediction rule were: Family history of skin cancer, history of outdoor work, age, phototypes 1-3 and the presence of poikiloderma of civatte, actinic keratosis and conjunctivitis in band. Prediction rules specificity was 87% for basal cell carcinomas and 92% for squamous cell carcinomas. Inter- and intra-observer reliability was good except for the conjunctivitis in band variable. Conclusions: The prediction rules let us calculate the individual risk of developing basal cell carcinoma and squamous cell carcinoma. This is an economic easy-to-apply tool that could be useful in primary and secondary prevention of skin cancer.

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Background: Esophageal carcinomas are very lethal disease relatively unresponsive to therapy. The continued development of new and more effective chemotherapeutic agents and regimens offers hope that in the future, this carcinoma may be amenable to either more effective palliative treatment or possibly increased cure. We, therefore, aimed to evaluate the marker with best diagnostic sensitivity in esophageal carcinoma. Materials and Methods: Serum carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), alpha-fetoprotein (AFP), and beta-human chorionic gonadotropin (β-HCG) levels were assessed in healthy subjects (n = 50) and patients (n = 50) initially diagnosed of esophageal carcinoma by endoscopic examination and biopsy before receiving any therapy. The data were analyzed using SPSS software version 10.0 (SPSS Inc. USA) and MedCalc to estimate mean ± standard deviation, the significance of the observed differences (P value), for calculating sensitivity and for plotting receiver operating characteristic curves. Results: Sensitivity of CEA, CA19-9, AFP, and β-HCG detected in esophagus cancer was 38%, 18%, 10%, and 26% respectively. Conclusion: From the above studied markers, CEA has the highest sensitivity followed by β-HCG, CA19-9 and AFP. Although the sensitivity of tumor markers in esophagus cancer is low, they may be useful additional parameter in the prediction of neoplasms involved at the early stage of tumor growth.

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Background: Head and neck (H and N) cancers are the leading cancer in elderly Indian population especially in Central India. Poor socioeconomic (SE) factors, lack of knowledge, and that of proper facilities is responsible for delayed presentation in advanced stages of the disease. Management of such patients is challenging for an oncologist. Aim: The present study evaluated the pattern of tolerance and response to treatment in elderly (>65 years) H and N cancer patients. Materials and Methods: Medical records of elderly H and N cancer patients presenting from January to December 2014 to the Department of Radiotherapy, Gandhi Medical College, Bhopal were reviewed, and data were collected from the departmental case files. Results: A total 112 patients were selected for this study. The mean age of presentation was 70 years. There was a marked male preponderance, with male to female ratio of 5.22:1. 102 patients presented in advanced stages (stage III and IV). The mean duration of symptoms was 6.5 months. Records of 99 patients were available and further analyzed. 59 patients were advised three courses of induction chemotherapy (CT) out of which 44 patients completed the treatment. 28 of these patients showed a positive response to the treatment while 16 showed no response (NR)/progression. Similarly, 24 patients were advised concurrent chemoradiotherapy out of which 17 patients completed the treatment. 13 of these patients showed a positive response while 04 showed NR/progression. On subgroup analysis, the difference between tolerance, response and overall treatment time between the two arms was not statistically significant. Conclusions: Treating elderly H and N cancer patients is a major therapeutic challenge for a clinician because of its poor prognosis, aggressive clinical behavior, associated co-morbidities, and SE factors. However, it is possible to achieve a quality outcome in select patients with basic CT and radiation.

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Rhabdomyosarcoma (RMS) is a highly aggressive, malignant tumor of skeletal muscle cell, associated with an early and a wide spread metastasis. Although a commonly occurring soft tissue sarcoma in the pediatric population, it is seldom encountered in adults. Outcome for adult RMS is poorly documented due to its rarity. We report a case of pleomorphic RMS (PRMS) in a 50 years male presenting with an intra-abdominal mass along with a swelling in the right inguinal region measuring 4 cm Χ 3 cm. Computed tomography revealed an ill-defined intra-abdominal mass arising from the peritoneum. Abdominal mass was resected along with the dissection of inguinal lymph node. Histopathological examination of these masses coupled with the immunohistochemistry, confirmed the diagnosis of PRMS metastasizing into inguinal lymph node. Despite of adjuvant radiotherapy and chemotherapy, the patient couldn't survive >3 months and died of widespread lung metastasis.

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Multilocular cystic renal cell carcinoma (MCRCC) is an uncommon low grade RCC with unique morphologic features. MCRCC also known as multilocular clear cell RCC is a rare cystic tumor of the kidney with an excellent outcome. MCRCC has been recognized as a separate subtype of RCC in the 2004 World Health Organization (WHO) classification of adult renal tumors. MCRCC is diagnosed on the basis of strict histological criteria according to 2004 WHO classification. It is usually included in the group of tumors of undetermined malignant potential with low nuclear grade. We present a case of MCRCC in a 43-year-old female patient who presented with pain in left lumbar region and hematuria. Left-sided radical nephrectomy was performed, and on histopathologic examination it was diagnosed as MCRCC with Fuhrman nuclear grade 1. Immunohistochemistry with epithelial membrane antigen and vimentin confirmed the diagnosis.

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Background: Free radical damage to biologic molecules forms a basis for cancer development. Since DNA damage and methylation states are influenced by oxidative species catalyzed by myeloperoxidase (MPO), this enzyme is postulated to have a role in the occurrence of cancer. MPO has been studied in cancers such as those of the lung, ovary, and breast. However, serum and salivary studies of MPO in oral cancer are lacking. Aims: (1) To determine the MPO levels in the serum and saliva of patients with primary oral squamous cell carcinoma (OSCC). (2) To compare and correlate the serum and salivary MPO levels in patients with primary OSCC and healthy controls. Subjects and Methods: A total of 30 subjects were involved in this study, of which study group consisted of 15 subjects and control group consisted of 15 subjects. Study group included subjects with histologically proven primary OSCC. Serum and salivary samples were collected from all the subjects. Results: The results showed that the serum levels of MPO were slightly higher in the study group as compared to the control group; however, the difference was not significant. In saliva, levels of MPO were slightly lower in the study group as compared to the control group. The difference was not significant. Conclusions: This study could not find a significant correlation between serum and salivary MPO and OSCC. However, our study consisted of a limited number of samples and as such can be considered a pilot study. Studies with larger sample size are needed to give better insight into the role of MPO in OSCC.

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Patients with leukemia may show involvement of the skin. This skin involvement can be due to infiltration of skin by leukemic cells or it may be a part of nonspecific cutaneous manifestations. Leukemia cutis is the infiltration of neoplastic leucocytes or their precursors into the skin resulting in extensive clinical manifestations. Described mostly in acute myeloid leukemia and acute myelocytic monocytic leukemia, it is rare in chronic myeloid leukemia and is seen mostly during the blast crises. Its presence signals poor prognosis.

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Adenoid cystic carcinoma (ACC) of the breast is a rare neoplasm and is known to have an excellent prognosis. We are presenting a case of ACC of the breast in a 59-year-old female diagnosed preoperatively by fine-needle aspiration cytology.

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Osteosarcoma (OS) is the most common primary bone tumor. Predominantly it is seen in the long bones of the body and rarely in the flat bones. Primary bone tumor arising from rib is most commonly chondrosarcoma, and rare reports of OS are there in the literature. Management of OS is multi-modal, including surgery and chemotherapy. However, radiotherapy plays a role in OS of flat bones when a complete resection is not possible due to cosmesis or surrounding vital structures. Here, we report a case of primary OS from rib, which was managed by surgery and chemotherapy.

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Clear cell odontogenic carcinoma is a rare neoplasm with very few cases reported in the literature. We report a case of a 50-year-old female patient with the malignancy at a less common location. Diagnosis was given based on the histopathologic findings. The demographic data and understanding for this tumor needs to be strengthened by reporting all new cases, which are diagnosed, in literature.

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Metastatic malignant melanoma is an aggressive rare skin cancer with fatal outcomes. Sole of the foot is often a lately identified site and misdiagnosed with other skin pathologies. We present a middle-aged male diagnosed with malignant melanoma of sole of the foot with extensive distant metastasis. He presented to the hospital with the complaints of enlarged inguinal lymph node. He was unaware of the lesion present on sole of the foot till it was diagnosed. Educational activities for health professionals and awareness programs for public are present day's need for identification of this disease in its early stage to enhance the possibilities of cure.

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Background: Human epidermal growth factor receptor 2 (HER2) status is an important biomarker and a molecular target for specific therapies such as humanized monoclonal antibody - trastuzumab. The aim of this study was to compare a group of the borderline positive HER2 (++) status patients with a strongly positive HER2 (+++) status group, according to clinicopathological features, cardiotoxicity, and treatment response. Materials and Methods: The analysis included medical records of 166 early and metastatic breast cancer patients treated with trastuzumab. Results: There were no significant differences between both groups in relation to patients' age at initial diagnosis and comorbid conditions; however, diabetes (4%) were observed only in tumors with strong HER2 overexpression. Patients with HER2 (+++) more frequently had a history of cigarette smoking in comparison with HER2 borderline women (39% vs. 25%, P = 0.06). There was no association between overweight and HER2 status. No statistically significant differences in steroid receptor status were detected between HER (++) and HER2 (+++) positive tumors (P = 1.00). Borderline tumors were in earlier stage of disease (50% vs. 17%, P = 0.002). Lymph node metastases correlate with strongly positive breast cancer (58% vs. 33%, P = 0.04). Second neoplasm also more often developed in strongly positive HER2 tumors and contralateral breast cancer in borderline. Conclusion: In the summary, borderline positive HER2 breast cancer patients are in earlier advance stage and have a better outcome than strong positive HER2 tumors. They are less predisposed to the development of cardiac side effects. Type 2 diabetes coexisted with strong HER2 overexpression.

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Spindle cell hemangioma (SCH) an uncommon vascular tumor typically appears as solitary or multiple cutaneous and subcutaneous nodules in middle-aged adults. Its occurrence in bone is extremely rare. We report a case of SCH arising at an uncommon site, the distal femur with radiological local invasion, but without histological pleomorphism and mitosis. It is important to avoid misdiagnosis as these lesions are considered to be benign, non-neoplastic reactive vascular proliferations, with high incidence of recurrence.

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Testicular lymphoma is the second most common extra nodal lymphomas. It is a highly lethal disease with a median survival of 1-2 years. In human immunodeficiency virus (HIV) patients, primary testicular lymphomas are estimated to comprise > 6% of testicular tumors, and they tend to occur in younger patients. Testicular lymphoma can occasionally be the initial manifestation of the disease in HIV patients.Plasmablastic lymphoma (PBL), which is considered as a variant of diffuse large B-cell lymphoma is a highly aggressive tumor with poor prognosis. PBL has a well-established association with HIV infection and occurs most commonly in the oral cavity. The presentation at extra nodal sites and absence of usual hematolymphoid markers makes its diagnosis more difficult. PBL of the testis as the primary lesion in HIV patients has not been reported so far. We report a case of PBL presenting as a primary testicular lesion in a HIV patient with a grave prognosis.

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Renal cell carcinoma (RCC) is an uncommon malignancy and is often associated with distant metastasis at the time of diagnosis. The adrenal glands, despite their close anatomical location to the kidneys, have a lower risk of tumor infiltration. The risk of metastatic deposits to adrenals is increased due to their high vascular supply. We present a young patient with RCC and metastases to the contralateral adrenal gland. We present the case to highlight the synchronous and the metachronous presentation of adrenal metastasis in renal cell carcinoma.

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Mesenchymal chondrosarcoma (MCS) of the head and neck is highly aggressive malignant small round cell neoplasm with cartilaginous differentiation, often with a pericytomatous vascular pattern. It represents approximately 0.1% of all head and neck neoplasms. Chondrosarcoma of orbit is extremely rare. We report a case of orbito-cranial MCS in a 24-year-old female who presented with exophthalmos. Imaging revealed a large heterogenous lesion arising from right orbit with intracranial extension. Patient underwent right fronto-temporal craniotomy with tumor decompression from intracranial part and right orbit. Histopathologic examination and immunohistochemistry was suggestive of MCS. Postoperative residual disease was treated with chemotherapy showing partial response.

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Contralateral breast magnetic resonance imaging (MRI) is of value in those patients with known or suspected malignancy. Women with unilateral breast carcinoma reveal an increased risk of suffering from malignancy in the contralateral breast. MRI of the breast has developed rapidly over past 20 years and is now firmly established as an important diagnostic tool and detects contralateral lesions in a substantial proportion of women. We present a case report of 67 years female who presented with blood stained discharge from left breast and MRI detected synchronous occult carcinoma in the contralateral breast. In this case report, we emphasize the importance of performing MRI on both the breasts and diagnosing synchronous occult carcinoma in the contralateral breast.

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Carcinoma ex pleomorphic adenoma (CEPA) is a rare malignancy arising from a primary or recurrent pleomorphic adenoma. Peak incidence is seen in octogenarian females. Delay in diagnosis of CEPA can be attributed to patients negligence owing to a mild nature of symptoms. CEPA is an aggressive tumor occurring mainly is major salivary glands such as parotid and submandibular glands.

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Molluscum contagiosum is a cutaneous viral infection presenting as multiple pearly white umblicated vesicles. Fine-needle aspiration cytology plays a pivotal role in establishing the rapid and correct diagnosis of clinically unsuspected cases, thereby aiding proper patient management. Our case report focuses on the diagnosis of molluscum contagiosum in a 30-year-old male with atypical presentation as a solitary ulcerated nodule on the right cheek.

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Massons tumor is a benign reactive intravascular endothelial proliferation. It is an unusual pattern of organization of a thrombus. We report a case of a 15-year-old boy with a small tumor nodule in the left temporal region of the face. Cytology was reported as fibrohistiocytic tumor. Histopathology showed the classic features of Massons tumor. In addition, there were onion whorl like areas and myxoid change. We have also highlighted the cytological features on a retrospective review.

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Primary extra osseous osteogenic sarcoma is one of the rarest forms of malignant tumor of the breast. It can arise as a result of osseous metaplasia of a preexisting neoplasm or from a none - phyllodes sarcoma of a previously normal breast. Due to its rarity, natural history and optimal treatment methods remain unclear. A 60-year-old patient presented to the surgical casualty with large breast abscess. Abscess wall histology revealed an osteosarcoma of the breast. Left total mastectomy with axillary clearance was performed. Histology and subsequent immunohistochemical studies confirmed the diagnosis of osteogenic sarcoma without lymph nodal metastasis. The patient was referred to the oncologist for further management. Rare types of breast tumors can be presented as breast abscess. Incision and drainage together with wall biopsy help to exclude associated sinister pathologies. Diagnosis of primary osteosarcoma of the breast was made using histological and immunohistochemical findings once the possible primary from the sternum and ribs were excluded. Treatment is as for sarcomas affecting other locations and should comprise a multidisciplinary approach.

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Waldenstrom's macroglobulinemia (WM) is a rare disorder and forms 1-2% of hematological malignancies. Rarely retinal detachment precedes the diagnosis of WM. In this case report, we present 65-year-old man with retinal detachment as the inaugural manifestation in WM. Clinical manifestations in WM are related to direct tumor infiltration, circulating immunoglobulin M (IgM) and deposition into tissues, amyloidogenic properties and autoantibody activity of IgM. Diagnosis is difficult, when a rare disease manifests differently, as in our case. Delay in diagnosis can be prevented by heightened awareness of this rare disease.

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Extranodal marginal zone lymphomas of mucosa-associated lymphoid tissue (MALT) are low-grade B-cell neoplasms, which arise in mucosal sites with prolonged lymphoid proliferation. Primary tracheal MALT lymphoma is an exceedingly rare entity for which the optimal treatment approach has not been determined. Here, we report a case of MALT lymphoma involving the trachea in a 64-year-old smoking woman who received desobstructive endoscopy and was thereafter successfully treated with (anti-CD20) immunotherapy and radiotherapy.

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Secondary metastasis tumors are the most common form of the adult intraocular neoplasm. It has an incidence of 9.3% among all fatal cases of cancer and 4% in patients dying of all types of cancer. We report a rare metastatic spread to the choroid from bladder carcinoma which is unusual primary site in a 64-year-old male. This case describes metastatic spread to the choroids from bladder carcinoma that is a very unusual primary site.

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Neuroendocrine tumors encompass a spectrum ranging from well differentiated benign carcinoid tumours (grade 1 neuroendocrine carcinoma) to a highly aggressive small cell carcinoma representing the extreme end of spectrum. We present an autopsy study of nonsyndromic bronchial carcinoid in a middle aged adult.

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Heterotropic splenic tissue in the renal fossa is characteristically asymptomatic and is usually an incidental finding that has been reported to mimic renal or adrenal tumors. A 50-year-old man with renal cell carcinoma had undergone radical nephrectomy with splenectomy because of the invasion of the splenic capsule. During a follow-up examination, nodules were detected by computed tomography in the subdiaphragmatic region. Although local recurrence was highly suspected, and these masses were diagnosed as ectopic splenic tissues by a technetium-99m-sulfur colloid scintigraphy and unnecessary surgical exploration was avoided.

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Sarcomatoid renal cell carcinoma (RCC) is a rare malignancy constituting 0.7% to 13.2% of all renal parenchymal malignancies. It is also called anaplastic carcinoma, spindle cell carcinoma or carcinosarcoma. The sarcomatoid differentiation is not a distinct histological entity, but it confers high aggressiveness on any subtype of RCC. Cytology of sarcomatoid RCC has rarely been described in literature. We describe cytology of a renal tumor that was later proven to be sarcomatoid RCC on histopathology and immunohistochemistry.

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Fluoride-18 fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) is increasingly applied in staging and treatment response assessment of lymphomas. Multiple isolated cases with extranodal involvement of non-Hodgkins lymphoma (NHL), detected on FDG PET-CT, have been previously reported. Here, we report a rare case of extranodal NHL involving multiple sites namely bilateral adrenals, liver and tibia in addition to supraclavicular, iliac and inguinal lymph nodes on FDG PET-CT and treatment response was assessed in follow-up FDG PET-CT.

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Cryptococcosis is an infection caused by yeast like encapsulated fungus Cryptococcus neoformans. Isolated primary pulmonary infection in an immunocompetent person is rare. We present a case, which was mistaken as carcinoma of lung and patient underwent pnemonectomy.

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