Background: Cervical Lymphadenopathy is one of the commonest and sometimes only clinical finding for a benign and malignant lesion. Fine needle aspiration cytology (FNAC) is a simple, safe, rapid and inexpensive method for establishing the diagnosis of lesions. Metastasis is more common in cervical lymph node and enlarged cervical nodes in an elderly patient must be considered as metastatic until proved otherwise. Methods: Retrospectively, 320 cases of left cervical lymph node FNAC were collected from five years record (May 2010 - June 2014) at Sri Devaraj Urs Medical College, Tamaka, Kolar. Review of all cytological reports were done according to standard guidelines and the morphological features of all non-neoplastic and neoplastic lesions were analysed. Results: Out of 320 cases 33% showed reactive lymphadenitis, 29% showed metastatic deposits, 14% showed features of granulomatous and necrotizing lymphadenitis, 9% were tuberculous lymphadenitis. In the present study, reactive lymphadenitis was the most common cause of enlarged lymph nodes followed by metastatic deposits. Squamous cell carcinoma is the most common metastatic lesions of lymphnode and comprise of 65% of the cases. Out of 62 cases of SCC 74% were keratinized, 16% were non keratinized, 29% cases showed granulomas. Non keratinization, presence of granuloma, plasma cells and eosinophils favours metastasis from nasopharyngeal carcinoma. Keratinization favours squamous cell carcinoma and absence of eosinophils and plasma cells in the background favors SCC metastasis from other sites. Conclusion: The present study highlight the usefulness of FNAC in left cervical lymphadenopathy where metastasis is common. Thus the knowledge about the cytological features and patterns will help the clinician to detect the respective cases early for investigations and treatment.

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Background: Ovarian cancer is the leading cause of mortality among all cancers of female genital tract in countries where effective cervical cancer screening program exists. As the world's population ages, remarkable increase in the total number of ovarian cancer cases are expected. This is preliminary epidemiological study to decide priorities in ovarian cancer research. Materials and Methods: A retrospective study was conducted with primary epithelial ovarian cancer cases registered in J. K. Cancer Institute, Kanpur (Uttar Pradesh), from 2007 to 2009. Patients' age at diagnosis, clinical feature, parity of patients, tumor histological type, Federation of Gynecology and Obstetrics stage, chemotherapy regimens, and overall survival data were collected and analyzed. Results: One hundred and sixty-three cases of primary ovarian epithelial cancer were analyzed. Patients' mean age at diagnosis was 55.98 ± 9.24 (median = 55). Serous adenocarcinoma (49.69%) was the most prevalent type of histopathology followed by endometroid (19.1%), mucinous (10.42%) and clear cell (4.29%). Combination of taxane and platin was most commonly used first line regimen in newly diagnosed as well as in relapsed patients post 1 year. Survival was not significantly different in various histopathology (log-rank P = 0.7406), but advancing stage demonstrated gradually poor survival (log-rank P < 0.05) when compared with early stage disease. Conclusion: Research efforts should be in the direction to find early diagnostic and effective screening tools as well as better therapeutic approaches for advanced epithelial ovarian cancer.

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Background: Primary lymphoma of the salivary gland is not often encountered in routine practice. About 5–10% of Non-Hodgkin's lymphomas (NHLs) are found in the salivary gland, most frequently involving parotid gland. Henceforth, it is necessary to understand the distinct clinical presentations and course of primary salivary gland lymphomas as this may help guide the proper diagnosis and management of patients with these tumors. Materials and Methods: We retrospectively reviewed primary NHL diagnosed at our medical institute over a period of 2 years. Results: Five cases of primary salivary gland lymphoma were found, two involving parotid gland while other three affecting submandibular gland. None of the cases had a clinical suspicion of lymphoma. However, they were diagnosed as having NHL B-cell type on histopathology. Conclusion: Since primary salivary gland NHL is an uncommon finding, it is often overlooked as the differential diagnosis. Methods of diagnosing and treating lymphoma are different from those of other benign pathologies of the salivary gland. Therefore, a high index of suspicion is warranted to provide a quick and efficient diagnosis and treatment without subjecting the patient to unnecessary tests and procedures.

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Spindle cell carcinoma (SpCC) of the larynx, a subtype and a more aggressive variant of the commonly occurring squamous cell carcinoma, is a unique and rare neoplasm. It comprises of 0.6–1.5% of all laryngeal cancers. Macroscopically, it usually presents as a large pedunculated, polypoidal mass with surface ulceration. Microscopically, however, it is considered as a biphasic tumor that has surface epithelial changes (in situ to invasive carcinoma) and an underlying mesenchymal spindle shaped neoplastic proliferation. If detected early, it has a very good prognosis. We present a case of SpCC in a 70-year-old male, who presented with progressive hoarseness since 1 year. The mass was removed under videolaryngoscopic guidance and thereafter, the patient underwent cobalt 60 radiotherapy. His symptoms gradually improved, and he regained good control of his voice.

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Background: Dendritic cell (DC)-based vaccination has shown promising application in tumor immunotherapy. However, it is not clear whether the presence of tumor impacts the efficacy of generation and functionality of DCs. Aim: To compare the phenotype of DCs generated from naïve or tumor bearing mice and their capability to restore leukopenia-associated chemotherapy. Materials and Methods: DCs were generated from bone marrow (BM) of naïve or Ehrlich ascites carcinoma (EAC) bearing mice. EAC is an undifferentiated breast cancer cell line with the high transplantable capability and rapid proliferation. BM cells were cultured in vitro for 7 days with granulocyte macrophage colony-stimulating factor and interleukin-4 (20 ng/ml each), loaded with different concentrations of EAC cell lysate (0.5, 1, 3 and 5 mg/10⁶) DCs followed by activation with the toll-like receptor 3 ligand poly(I:C). For DC-based vaccination, CD1 mice (n = 5/group) were inoculated with an intraperitoneal (i.p.) injection of 0.25 × 10⁶ EAC cells to form ascites, treated on day 14 with an i.p. injection of cyclophosphamide (4 mg/mouse) and on day 15 with subcutaneous injection of 2 × 10⁶ DCs from control or EAC bearing mice. Injected DCs were loaded with or without EAC lysate followed by i.p. injection of 50 μg/mouse poly(I:C). On day 21, mice were bled and sacrificed for peripheral blood count and spleen and BM cellularity. Results: Yield of DCs generated from naÏve or EAC bearing mice, as well as their phenotype (CD11c⁺ CD11b⁺) and activation (CD40 and CD80) with poly(I:C) were similar. Loading DCs with 1 mg EAC lysate induced better viability and activation phenotype as compared with the other concentrations. Regardless the source of DCs, DCs vaccination restored the total numbers of leukocytes in blood but not in the spleen and BM. The effect on peripheral blood leukocytes was coincided with the restoration of the relative numbers of lymphocytes, monocytes, and granulocytes. Conclusion: These data support the use of allogenic DCs from healthy donors in anticancer DC-based vaccination.

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Primitive neuroectodermal tumor (PNET) and Ewing's sarcoma (EWS) are small round cell tumors occurring mainly in children and adolescents. Their occurrence in adults is rare. The abdominal cavity and retroperitoneal PNET/EWS are also relatively rare, grow rapidly in size, compressing surrounding organs/large vessels, and make surgical resection difficult. We report one such rare occurrence of a retroperitoneal PNET in 41-year-old male who presented with abdominal pain and constipation. Contrast enhanced computed tomography abdomen showed large lobulated necrotic hypodense enhancing lesion extending from epigastrium to hypogastrium and involving entire abdomen. Excision of retroperitoneal mass with omentectomy was done. Microscopic examination revealed a malignant small round cell tumor with homer wright rosettes and the tumor cells were positive for CD99.

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Background: Hepcidin is the master regulator of iron homeostasis but until now, data about its expression in acute lymphoblastic leukemia (ALL) is scarce. Objectives: To evaluate hepcidin level in a group of ALL children in different treatment phases, investigating its relation to serum ferritin and erythroid activity. Materials and Methods: Forty ALL children were included and categorized into; Group I: Included 20 newly diagnosed ALL children who were evaluated at diagnosis and after remission. Group II: Included 20 ALL children in the maintenance phase of therapy. Twenty age and gender matched healthy children were enrolled as a control group. Complete blood count including reticulocytes %, liver functions, renal functions, and C-reactive protein were assayed. Serum hepcidin and ferritin were measured by enzyme-linked immunosorbent assay. Results: Serum hepcidin and ferritin levels were significantly higher among both ALL groups compared to the controls. These values were higher before therapy than after remission in the newly diagnosed group as well as than the maintenance group. Before therapy, both serum hepcidin and ferritin levels had significant negative correlation with hemoglobin and reticulocytes % while directly correlated with each other. Conclusion: Hepcidin level increased in ALL children at diagnosis and in different treatment phases. The highest rise was at diagnosis. These results indicate that hepcidin level among ALL patients is under the opposing effects of the iron stores and erythroid activity with the net level is determined by the strength of each stimulus.

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Metastatic disease to the heart is a rare phenomenon. In this case report, we describe an unusual case of metastasis of breast cancer to the left side of the heart in an elderly lady, with its intracardiac location detected by means of transthoracic echocardiography. This is one of the few described case reports of breast cancer metastasizing to the left ventricle of the heart.

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Giant cell carcinoma of uterus is an aggressive form of endometrial carcinoma. It can be confused on histopathology with other giant cell containing lesions including trophoblastic tumors, certain primary sarcomas, and malignant mixed müllerian tumors. Due to the paucity of cases of this rare subtype, the prognostic parameters are difficult to assess. We describe here one such case in a 60-year-old female who presented with postmenopausal bleeding. To the best of our knowledge, this is the 13^th case being reported in world literature. We intend to describe this case due to its rarity, failure to recognize this tumor as a subtype, and lack of definition and guidelines in the literature for accurate classification.

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The keratocystic odontogenic tumor (KCOT) is a frequently encountered developmental cyst of the jaws. The occurrence of KCOT in the maxillary sinus is rare. The mucosa of the maxillary sinus is susceptible to infections, allergic diseases, and neoplasm. The anatomic position of maxillary premolar and molar teeth is in close contact with the sinus predispose to spreading of pulp and periodontal infection, odontogenic cyst, and tumors to the sinus. Diagnosis and treating KCOT in maxillary sinus is challenging as treatment has to be rendered for sinusitis because of pathology in the sinus and for KCOT. We report a case of 35-year-old female with KCOT involving the lining of the maxillary sinus and put forward hypotheses for the origin of KCOT in the maxillary sinus.

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Paucicellular variant is a rare variant of anaplastic carcinoma. Anaplastic thyroid carcinomas usually creates no problems in histologic diagnosis because of the obvious invasive growth, high cellularity, and marked degree of anaplasia, but paucicellular variant of anaplastic carcinoma is problematic in diagnosis because of its histologic mimicry to benign lesions, e.g. Riedel disease and fibrous variant of Hashimoto thyroiditis, i.e. prominent fibrosis and low cellularity. It is important to distinguish it from these two lesions because both are reactive conditions with favorable prognosis while anaplastic carcinoma is a malignant condition with poor prognosis. We present a case of 45-year-old female presented with a history of thyroid swelling for 10 years. The cytological diagnosis was given as colloid goiter while histopathological examination turned out to be paucicellular variant of anaplastic carcinoma thyroid. To conclude paucicellular variant is the entity to which all pathologists should be familiar and should know differential diagnosis while dealing with any fibrosed lesion of the thyroid.

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Primary pleural synovial sarcomas (SSs) are rare tumors comprising <1% of all primary lung tumors. They are frequently misdiagnosed as relatively more common entities such as malignant mesothelioma. We present one such rare case of biphasic SS in the pleura of a 40-year-old female who presented with massive right hemothorax, and computed tomography revealed a pleural-based tumor in the right lung. Histopathological examination of the excised tumor was suggestive of biphasic SS. Immunohistochemical staining showed positivity with antibodies against cytokeratin 7, epithelial membrane antigen, vimentin, and bcl-2.

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Bronchogenic carcinoma often manifests with some atypical symptoms which delay the diagnosis of malignancy. The primary manifestation of lung cancer with pathological fracture of humerus due to skeletal metastasis is very rare. We hereby report such a case in an elderly nonsmoker male who initially presented with nontraumatic painful swelling of right arm which was found to be due to humeral fracture. However, initial management by the orthopedic surgeon over 3 months did not provide adequate relief. On subsequent evaluation, chest X-ray showed a right hilar mass. Further radiologic imaging and a guided biopsy from lung mass confirmed an adenocarcinoma. Fine needle aspiration from humeral osteolytic lesion also confirmed metastatic deposit. This case highlights the importance of suspecting pathological fracture while dealing with nontraumatic fracture, especially in elderly patients, which avoids the diagnostic delay.

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Germ cell tumors (GCTs) are common tumors of gonads. Their occurrence at extragonadal sites, either as primary tumors or as metastatic foci, is rare. Extragonadal GCTs have a prevalence of 1–2.5% of all GCTs with mediastinum being the most common site of involvement, followed by retroperitoneum, pineal gland, and sacrococcygeal region. Involvement of other extragonadal sites, including lymph nodes, is usually associated with metastatic disease. We report a case of a young female with an atypical presentation of a swelling in the left neck region creating a clinical and pathological dilemma.

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Extraosseous ameloblastoma (EA) is a rare odontogenic tumor which comprises about 1% of all ameloblastomas. Extraosseous location is the peculiar feature of this type of tumor, which is otherwise similar to the classical ameloblastoma. The exact etiology of EA is not yet known. The clinical appearance may vary; it presents as a slow-growing, firm, painless mass with a sessile or pedunculated base with a smooth surface. The radiographic findings are nonspecific; diagnosis is based on histopathological features. It poses a diagnostic and therapeutic challenge due to its morphology and biological behavior. This article aims to elucidate rare case of EA of maxillary gingiva in a 40-year-old male patient and also an attempt has been made to discuss its pathogenesis in light of current information from the literature.

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Malignant melanoma is a malignancy that develops from melanocytes. Breast is an uncommon site for malignant melanoma. Melanoma of the breast occurs in various situations such as primary melanoma of breast skin, metastatic melanoma of breast, in-transit metastasis to the breast, and primary glandular breast melanoma. Most of the melanoma breast either cutaneous melanoma or metastatic melanoma. Primary glandular melanoma of male breast with nodal involvement is rarely reported compared to primary cutaneous melanoma breast. Here, we report a case of primary glandular melanoma of male breast with nodal metastasis. This case reported to highlight about primary glandular melanoma breast and early diagnosis of melanoma breast.

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Squamous cell carcinoma of the external auditory canal, middle ear, and temporal bone is a rare and unusual malignancy. The rare occurrence of the disease makes the formulation of uniform treatment guidelines and appropriate management challenging. The role of chemotherapy in this disease is not clearly defined in literature. We describe a clinical case of a patient with this rare malignancy and an excellent response achieved with nanoparticle - albumin-bound paclitaxel and present a comprehensive review of literature.

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Leiomyomas are benign smooth muscle tumors that can arise from any organ, but are infrequently seen in the genitourinary tract. We present a case of a 55-year-old gentleman with a history of swelling in left testis since 6 months associated with pain. A clinical diagnosis of seminoma was made. On ultrasound, the same lesion was reported as mass with homogenous echogenicity with orchitis. However, histopathological examination revealed a diagnosis of tunica albuginea leiomyoma. Tunica albuginea leiomyomas are a rare entity. This case report highlights the awareness of tunica albuginea leiomyomas, which can be clinically mistaken for malignant testicular tumor.

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Squamous cell carcinoma of the larynx is the most common histologic type, accounting for up to 90% of cancers with more predilections to spread locoregionally to the cervical lymph nodes. Distant metastasis, usually to lungs, bone, and liver is seen much less frequently, with an overall incidence of 6.5–7.3%. A case of 55-year-old male with the previous history of surgery and radiotherapy treated squamous cell carcinoma of the larynx, presenting with a chief complaint of pain abdomen is hereby reported for its unusual diagnosis of metastatic deposits of squamous cell carcinoma in the omentum. Though there are reference available for peritoneum as the distant metastatic site for hypopharyngeal carcinoma, reference for laryngeal carcinoma metastasizing to omentum were not found even with an extensive search of literature. Awareness of unusual sites of distant metastasis such as omentum must be kept in mind for treated laryngeal carcinoma patients presenting with non-specific symptoms like pain abdomen. And also, chances of involvement of unusual site of the distant metastasis increases with advanced tumor-node-metastasis stage and nodal status.

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Multiple endocrine neoplasia-2A (MEN-2A) is a rare syndrome. MEN-2 is characterized by medullary thyroid carcinoma (MTC), pheochromocytoma, and hyperparathyroidism. MTC is the most consistent feature in all subtypes of MEN-2. In MEN-2A, approximately 70–95% of individuals develop MTC, 50% develop pheochromocytoma, and 15–30% develop hyperparathyroidism. Identification of a germline REarranged in transfection mutation or the identification of the clinical features of MEN-2A in other first-degree relatives is required to make the diagnosis, in those patients with only one or two clinical features. We present the case of a family with MEN-2A syndrome. Here, the patient was first operated for MTC and following further investigation was detected to have pheochromocytoma. In her family history, she had a daughter who was earlier operated for MTC. After 5 years of follow-up, she is doing well. This is an additional case of MEN-2A.

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Renal cell carcinoma (RCC) has widespread and unpredictable metastatic potential, even when the curative nephrectomy is performed. RCC can metastasize via venous and lymphatic routes virtually to any site but commonly metastasizes to lungs, lymph nodes, bones, liver, and brain. Muscular metastases are rare from RCC. After 22 years of curative radical nephrectomy and disease-free follow-up, the patient presented with discomfort on walking and climbing upstairs and also complained of thigh swelling confirmed on clinical examination. Noncontrast computed tomography showed mass lesion in quadriceps muscle (vastus intermedius), fine needle aspiration cytology revealed metastatic deposits of RCC. Rest of the metastatic evaluation was normal. In long-term survivors of RCC, skeletal muscle survey (SMS) should be included in addition to metastatic evaluation for other sites, as the current case is an eye opener for the inclusion of SMS in the metastatic evaluation of such patients.

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Glioblastoma multiforme (GBM) is the most aggressive form of primary brain tumor. The median survival time is 14 months. Extracranial metastases from GBM are even rare, with a reported frequency of only 0.44%. A rare case of GBM with bone metastases is presented in this paper. This is the first such case reported at Gujarat Cancer Research Institute, which is a radiotherapy center with maximum cancer patient load in India.

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Male breast carcinoma is rare as compared to female counterpart accounting for <1% cancers in men. Various studies have shown that prognosis of breast carcinoma in males is poor than females. Moreover, mucinous carcinoma is an extremely rare histological subtype, and only ten cases are reported in literature. Metastasis to lymph nodes is rare event and also carries good prognosis. We hereby report a case of pure mucinous carcinoma in a 72-year-old male with metastasis to axillary lymph nodes. This case will add the rare reports in literature of this rare tumor.

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Malignant adenomyoepithelioma of the breast is a rare lesion characterized by malignant proliferation of epithelial and myoepithelial cells that show characteristic histologic and immunohistochemical features. Metastases associated with these tumors are usually hematogenous. Axillary lymph node metastases are thought to be unusual. It has been recently suggested that axillary node dissection is not indicated unless clinically palpable. We present a case of a 35-year-old woman, who developed a malignant adenomyoepithelioma with axillary lymph node metastasis that included epithelial and myoepithelial elements.

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Echinococcosis or hydatidosis caused by the tapeworm, Echinococcus granulosus, has the highest prevalence in endemic regions and sheep farming areas. The most common organ involved is the liver (50–75%) followed by the lungs (15–20%) and other organs (10–20%). Primary involvement of the kidney without the involvement of the liver and lungs, i.e., isolated renal hydatid disease is extremely rare even in endemic areas. The incidence of renal echinococcosis is 2–4%. Renal hydatid cysts usually remain asymptomatic for many years and are multiloculated. A 63-year-old male presented with left loin pain. Computed tomography scan abdomen revealed a presumptive diagnosis of renal hydatid disease. The nephrectomy specimen received in histopathology confirmed the diagnosis. We describe a rare case of primary renal hydatidosis.

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