Cardiovascular disease is on the rise. In India and other developing countries, rheumatic heart disease (RHD) continues to be a major public health problem and contributes to significant cardiac morbidity and mortality. RHD in the juvenile age group namely juvenile mitral stenosis is a variant which is unique to the Indian subcontinent. Severe valve deformities lead to high morbidity and mortality. Despite various measures no appreciable decline in prevalence of RHD has been documented. At autopsy, mitral valve was most commonly affected either alone or in combination with aortic and tricuspid valves. Both functional and organic involvement of tricuspid valve was documented. It has been convincingly demonstrated that molecular mimicry between Streptococcus pyogenes antigen and human proteins lead to autoimmune reactions both humoral and cell mediated causing RF/RHD. Heart tissues namely the valves, left atrial appendage (LAA) and myocardium reveal variable amounts of infiltration by lymphocytes. Significant endocarditis and valvulitis is observed in these cases. CD4+ T cells are most likely the ultimate effectors of chronic valve lesions in RHD. They can recognize Streptococcal M5 protein peptides and produce various inflammatory cytokines such as TNF-alpha, IFN-gamma, IL-10, IL-4 which could be responsible for progressive fibrotic valvular lesions. Cardiac myosin has been defined as a putative autoantigen recognized by autoantibodies of RF patients. Cross reactivity between cardiac myosin and group A beta hemolytic Streptococcal M protein has been adequately demonstrated. Cardiac myosin has been shown to produce myocarditis in rats and mice. Valvulitis/ endocarditis has been observed in excised LAA, cardiac valves and in hearts at autopsy from cases of RHD. The disease predominantly affects the valvular endocardium culminating in crippling valve deformities. Endocardial infiltrate and their migration into the valve substance has been elegantly demonstrated in rats and mice. Immune responses against cardiac myosin lead to valvular heart disease and infiltration of the heart by Streptococcal M protein reactive T lymphocytes. Mitral valves showed various degrees of calcification. An interesting observation is the nature of calcification in diseased/distorted valves in RHD. Recent studies indicate that calcification is not merely an inactive, "dystrophic" process but involves a regulated inflammatory process associated with expression of osteoblast markers and neoangiogenesis. Increased plasma osteopontin levels correlated with severity of mitral valve calcification. Further evidence of inflammation is supported by high levels of advanced oxidation protein products and high sensitive C-reactive protein in plasma detected in patients with RHD. Presence of inflammatory cells and increased expression of several cytokines in cases of "end stage" RHD reflects a possible subclinical, ongoing insult/injury to some unrecognized antigenic stimulus by beta hemolytic Streptococcal antigens that have sensitized/primed the various target tissues and which further culminate in permanent valve deformities.

Remarkable changes are seen on gross and microscopic examination of placenta of patients with sickle cell disorders, hence the present study was undertaken to find out the pathological changes seen in the placenta of sickle cell disorder patients, as compared to control and to study the effect of maternal sickling on the fetus. It includes total 73 cases, of which 10 were of control group and 63 were from patients with sickle cell disorders, which included 47 sickle cell trait (AS) and 16 sickle cell disease (SS) patients. In group II, 9 (14.28%) patients with SS pattern developed complications during pregnancy, in the form of vaso-occlusive and hemolytic crises. Pregnancy induced hypertension was seen in 4 (25%) out of 16 SS and 11 (23.40%) of the 47 AS patients. Urinary tract infection (UTI) was seen in 6 (37.5%) out of 16 SS and 8 (17.02%) out of 47 AS patients. Placentae in sickle cell disorders showed pathological changes in the form of infarction, calcification, sickled red blood cells and hemorrhage in intervillous spaces, increased syncytial knots, fibrinoid necrosis, stromal fibrosis, hyalinised villi and compensatory proliferation of trophoblastic cells.

The present study was taken with an aim to assess the prevalence of H. pylori in patients with gastric carcinoma and correlate it with gross appearance and histological type. Endoscopic biopsies from 54 patients with gastric carcinoma and 50 age and sex matched controls were taken after thorough upper gastrointestinal examination. Gross appearance of the tumour was noted and two biopsies each from the site of malignancy and from normal appearing areas were taken. Sections were stained with Haematoxylin & Eosin and Loeffler's methylene blue for histopathological details and presence of H. pylori. Prevalence of H. pylori in controls was slightly higher than the patients group (80% Vs 78%). Ulcerated type of gross appearance had maximum prevalence of H. pylori (88%). Prevalence of H. pylori was more in diffuse type of gastric cancer than intestinal type (86% Vs 68%). A significant association between H. pylori and grades of gastritis was noted (P < 0.01) in controls as well as in patient group but it failed to show a significant association with tumour grades, intestinal metaplasia, site of the tumour and age of the patients. So, it can be inferred that prevalence of H. pylori infection is not directly associated with pathogenesis of gastric cancer but it may act as a co-carcinogen by damaging the mucosa and thereby making it more susceptible to effects of carcinogen.

This study investigates the role of cyclin D1 in 30 uterine surgical resection and endometrial biopsy specimens from 30 patients with simple hyperplasia (10 cases), complex hyperplasia (6 cases) and endometrial carcinoma (14 cases). Cyclin D1 immunohistochemistry was performed on 2-4 mm thick paraffin sections using labelled streptavidin biotin kit. Cyclin D1 expression was present in 2/6 (33%) cases of complex hyperplasia, 7/14 (50%) cases of endometrial carcinoma and none in simple hyperplasia. Difference in cyclin D1 immunopositivity in simple hyperplasia and endometrial carcinoma was statistically significant (p = 0.018) but the difference in cyclin D1 immunopositivity between complex hyperplasia and endometrial carcinoma was not statistically significant. Our study suggests that cyclin D1 over-expression may be an early event in endometrial carcinogensis. Since there was no difference in extent and intensity of cyclin D1 expression between complex hyperplasia and endometrial carcinoma, it appears that deregulation is maximal in complex hyperplasia.

The exact mechanism and aetiological factor for hepatocarcinogenesis is not yet well defined. Besides genomic integration of hepatitis B viral particles, persistent chronic inflammation is postulated to be important initiating factor in viral related hepatocellular carcinoma (HCC). The objectives of the present study were--to correlate histological profiles of chronic liver disease in the adjoining non-tumor liver tissue in HCC with liver enzymes, to compare with those of non-carcinomatous chronic liver disease cases using the liver tissue and data collected at autopsy, and to correlate with hepatitis B and C positive status. Post mortem liver and data available at autopsy were used for the study. Changes of chronic liver disease was graded and staged according to Peter Scheur's (1991). In HCC, the non-malignant liver tissue was used for the study. Hepatitis B surface and core antibodies were demonstration by immunohistochemistry. HCV was documented by RT-PCR using the tissue extract of paraffin embedded liver tissue. HCC group had higher inflammatory grading and transaminases levels than non-HCC group. HBcAg alone and dual HBcAg and HCV positive cases were more in HCC group. Incidence of biliary epithelial cell injury was higher in HCV positive subgroup. Conclusion: higher incidence of inflammatory grading and enzyme level in alone HBcAg and dual HBcAg and HCV positivity in HCC group would suggest significant role of ongoing persistent chronic inflammation and actively replicating HBV and HCV infections in carcinogenesis.

Rhinosporidiosis is endemic in the state of Chhattisgarh. 462 cases were encountered during the period of 12 years from January 1994 to December 2005. Maximum incidence was seen in men in the age group of 21-30 years. Nose and nasopharynx were the commonest site (81.1%), followed by ocular tissue (14.2%). Many rare sites of involvement were encountered. Seven cases of generalized rhinosporidiosis were seen. Rhinosporidium seeberi could be easily identified in Haematoxylin and eosin stained sections. Sporangias and spores are better delineated by periodic Acid Schiff, Mayer's mucicarmine, Verhoff's vonGieson and Grocott Gomori methamine silver stain.

3 cases of primary non Hodgkins lymphoma of the breast are described, seen over a period of 2 years among 199 cases of breast malignancies. All were diffuse large B cell type. Application of immunohistochemistry greatly aids in differentiating lymphoma from anaplastic carcinoma, with which it can easily be confused. Preoperative diagnosis on a trucut biopsy is an ideal diagnostic method since diagnosis on fine needle aspiration cytology or frozen section may not be possible. Primary breast lymphoma is a rare disease with reported incidence of 0.04-0.53% of all breast malignancies in most series. Accurate diagnosis is essential, so that appropriate treatment may be applied. Two cases were treated with CHOP chemotherapy and radiotherapy along with surgical excision. One case was treated with CHOP chemotherapy.

The objective of the present study is to observe the spectrum of histopathological changes in the testicular biopsies of infertile men and to assess if a bilateral biopsy is required to reveal the pathology of infertility in every case or a unilateral biopsy would suffice. Thirty testicular biopsies (21 bilateral and 9 unilateral) were studied from 30 infertile men. The patterns of testicular damage seen in the present study were maturation arrest followed by hypospermatogenesis, Sertoli-cell only syndrome, tubular hyalinisation and one case was associated with normal histology. Comparing the histopathological findings in bilateral biopsies, it was seen that a unilateral biopsy would suffice to reveal the pathology in most instances and a bilateral biopsy is needed only when there is appreciable difference in the size of the testes.

Direct Immunofluorescence (DIF) is invaluable in the diagnosis of cutaneous vesiculobullous lesions (VBL). It is limited by technical factors and disease nature. 1) To record the sensitivity of DIF in VBL 2) To correlate DIF with clinical, histologic findings and analyse discrepancies. Material and Methods: A retrospective study of 100 DIFs on suspected VBL of skin. DIF, histology and clinical data were reviewed. 73/100 cases showed DIF patterns concordant with clinical/histologic diagnosis. The sensitivity of DIF was 88% in Pemphigus group (39/ 44), 82% in Bullous Pemphigoid (BP) (23/28), and 20% in Dermatitis Herpetiformis (DH) (1/5).18 cases of histologically proven VBL were negative and of these, 4 had no epidermis. The remaining 9 cases were discordant with clinical/histologic features, including 4 BP and 5 DH, whose histology was non-specific and will be discussed in detail. One case of DH showed an aberrant vasculitic pattern. DIF is of great value in the diagnosis of VBL, specially in clinical/histologic dilemmas. In DH, neither biopsy nor DIF were very useful and response to therapy was the standard. Sampling errors contributed to false negative results. Proper selection of cases and judicious use are mandatory to optimize its' utility.

High-risk human papillomavirus (hr-HPV) testing is widely used, but different DNA isolation methods may give variable results in PCR determinations. To evaluate the effect of different DNA isolation methods on the HPV results, DNA was isolated from 180 consecutive cervical samples with the manual Amplilute kit, or the standard automated or a modified MagNAPure LC (MPLC) protocol. The DNA was then tested for hr-HPV with the AMPLICOR HPV-test, and the HPV-genotype was determined with the Linear Array (LA) test. The concordance of the three DNA isolation methods is 90-93% and 88-92% between the HPV-tests from DNA isolated by any of the three isolation methods and LA. The sensitivity, specificity, percentage of false negatives and false positives compared to the LA detected hrHPV subtypes are similar for the manual and standard MPLC, but the specificity of the modified MPLC was much lower and the percentage of false positives much higher. In conclusion both the manual and standard MPLC DNA isolation methods give good HPV results. The standard MPLC is the fastest DNA isolation method.

Scarce reports relying on rapid urease test, serology and histopathology are currently known for H. pylori from Western India, Maharashtra. We investigated H. pylori genotypes at molecular level in gastro-duodenal disease population during the years 2002-2005. H. pylori presence was scored by polymerase chain reaction in the infected biopsies (n = 95) in various gastric diseases. H. pylori specific 16S rDNA gene amplification based preliminary identification coupled with protein coding gene amplification scores were assessed for the incidence. H. pylori 16S rDNA and 7 housekeeping genes were detected in all biopsies, whereas 71.18% and 28% found to be cagA positive and negative respectively. The vacA toxigenic alleles (vacA s1) and middle region subunit vac m1a were found in 54%, and 59% patients. However, the iceA1 was present in 40.06%; the iceA2 was less i.e. in 13.5% patients. The most common allelic combinations in different age groups irrespective of disease types were 13-30, 31-45, 46-60 and 61-73 were cagA-vac m1a-vacA s1-iceA1. In our analysis, PCR was found to be 100% accurate in detecting H. pylori in gastric biopsies. Among West Indian population H. pylori was found to be present, irrespective of any correlation with the genotype and gender of patients with the clinical outcome. However, the genotype incidences were related to age of the patients, wherein the age group ranging from 46 to 60 years was found be susceptible for H. pylori infection.

The objective of this study is to analyze the deferrals in static telepathology consultation service. A store and forward approach is used to transmit cases from two remotely located rural centers to Tata Memorial Hospital. A total of 346 tele-surgical pathology cases were accessioned for second opinion and were reported from January 2002 to August 2005. The glass slides and paraffin blocks were reviewed at a later date and the telepathology diagnosis was compared with the final diagnosis rendered on light microscopy. Of all 251 teleconsults referred from one of the referring centers, a telepathology diagnosis was rendered in 205 cases and 46 cases were deferred. The reasons for deferral were as follows: the requirement for ancillary studies (40 cases), clinical details (5 cases) and poor quality sections and images (1 case). In all these deferred cases, a probable diagnosis was rendered by the telepathologist and was compared with the final diagnosis after paraffin block evaluation. In 47% of the cases, the "probable" diagnosis on telepathology matched the final diagnosis.

The accurate grading of astrocytic tumours is of prime importance because it is critical to the patient management and survival/outcome. Although internationally accepted WHO grading system of CNS tumours is based on histological features of H&E stained sections, yet there are cases where differentiation between grade II and grade III is difficult particularly when the biopsy is small. Proliferative index derived from MIB-1 immunostaining has been found to be useful in the distinction between various grades of malignancy. Formalin-fixed paraffin-embedded surgical specimens from 90 cases of astrocytic tumours, 30 each of low-grade astrocytoma (grade II), anaplastic astrocytoma (grade III), and glioblastoma multiforme (grade IV), were immunostained by standard indirect immunoperoxidase technique using MIB-1 monoclonal antibody. MIB-1 labeling index (MIB-1 LI) was calculated. The mean MIB-1 LI values of astrocytomas, anaplastic astrocytomas and glioblastomas were 1.75 +/- 1.5%, 8.74 +/- 6.2%, and 20.54 +/- 12.2% respectively and there was statistically significant difference between grade II and III (Unpaired "t" test, T value 5.907, p value < 0.001) and grade III and grade IV (T value 4.734, p value < 0.001). The statistical analysis also revealed that the mean MIB-1 LI increased with histological grade of malignancy (One way ANOVA test, p value < 0.001). This investigation further reinforces and corroborates the findings that MIB-1 LI is useful tool in assigning grading to the astrocytic tumours and hence in treatment modalities and should be used routinely.

Prostate cancer metastasis to the axial skeleton occurs at high frequency in patients with advanced disease causing significant morbidity and mortality. Apart from bone, brain is also a common site of metastasis but the involvement of the parietal bones is extremely unusual. Parietal bone metastasis from prostatic adenocarcinoma was the initial presentation seen in our patient. This is the first case of its kind in the literature where the prostatic carcinoma had metastasized to the parietal bones of the skull without any symptomatology of prostatic involvement. The report is intended to alert the reader of this rare site of metastasis from the prostate.

Myoepithelioma of soft tissue is a recently categorized entity and myoepithelial carcinoma is extremely rare. We describe a case of myoepithelial carcinoma of soft tissue in a 30-year-old male patient, who presented with a painless mass located at the back of left leg involving popliteal fossa that was present since childhood. A wide local excision was performed. The distinct histopathological features included infiltrative margins, cytologically moderate to severely atypical epithelioid/spindled cells with prominent nucleoli, 3-4 mitoses/10HPF, tumor necrosis and lymphovascular invasion. No heterologous elements were identified. The myoepithelial origin was confirmed by positive immunohistochemical staining for S100 protein, epithelial membrane antigen and smooth muscle actin. Mib-1 (Ki-67) proliferation index was 20-25%. These carcinomas have variable clinical presentation and can have an indolent course for several years. Recognition of myoepithelial carcinoma is clinically significant because compared to its benign counterpart, this has increased frequency of local recurrences and metastases that warrants a close clinical follow-up.

A rare case of primary mucinous eccrine carcinoma of the lower eyelid in a 45 year old female is described. The lesion was diagnosed clinically as melanoma. We report this case because of unusual nature of this tumor and rare presentation in a female patient.

Review of records for last 5 years has shown 4 cases of Type I Gaucher's disease in our institute. The cases were diagnosed on bone marrow aspiration, examination of splenectomy specimen, liver biopsy and post mortem in one case. The age range was 2 years to 22 years. Male to female ratio was 3:1.Splenectomy was performed in one case and one case received enzyme replacement therapy with high dose, low frequency regimen for six months without any favorable effect. All were Hindus. Family history of similarly affected and treated twin brother was available in one case. The predominant clinical presentation was pancytopenia and splenohepatomegaly with splenomegaly greater than hepatomegaly. Remarkable constitutional inferiority was noted in one case, which succumbed to death following acute illness and bleeding diathesis. Post mortem performed showed infiltration of spleen and liver with Gaucher cells, fibrosis and myeloid metaplasia in liver and lung.

A 29 year female presented with epigastric pain with bilious vomiting since 1 1/2 years. This patient was diagnosed as a case of Peutz-Jegher's syndrome based on evidence of the characteristic mucocutaneous pigmentation which was present since birth and intestinal hamartomatous polyposis. There was an associated unilateral ovarian cystadenoma which is a rare association and which highlights the importance of a gynaecologic examination in female patients with Peutz-Jegher's syndrome.

Kimura disease is a rare form of chronic inflammatory disorder involving subcutaneous tissue, predominantly in the head and neck region and frequently associated with regional lymphadenopathy and/or salivary gland involvement. We present a case of Kimura disease in a 28-year-old male which showed florid squamous metaplasia in the salivary gland ducts and salivary duct inclusions in the intraparotid nodes besides the usual features of Kimura disease. The squamous metaplasia was extensive enough to pose a diagnostic dilemma. We describe this case to highlight the rare histological finding of florid squamous metaplasia in Kimura disease and its diagnostic implications.

Solitary myofibromas are relatively rare neoplasms but one of the most common fibrous neoplasms occurring in infancy and childhood. Adult cases have also been reported in the literature. We describe here a case report of an eighteen-month-old child who presented with a gradually enlarging nodule in the right breast. The case is presented for an insight into contemporary knowledge about its histogenetic origin, behaviour and prognosis.

Ovarian tumors have occasionally been reported in pregnant women, the incidence as per literature being 1 in 81 to 1 in 2000 pregnancies. Out of this, about 2-5% are malignant, thus contributing to the rarity of malignant ovarian tumors in pregnant women. One such occurrence in a 24-year old female patient is reported here considering its extreme rarity.

Angiosarcomas are uncommon malignant neoplasms characterized by rapidly proliferating extensively infiltrating anaplastic cells derived from blood vessels and lining irregular, blood-filled spaces. The cells manifest many of the functional and morphological properties of normal endothelium. They are collectively one of the rarest forms of soft tissue neoplasms. Here we present two cases of pericardial angiosarcoma, one of them showing widespread dissemination, which caused considerable diagnostic dilemma and the diagnosis could only be established very late in their course of disease.

Recurrent chondroblastoma with pulmonary and palatal metastasis is a rare occurrence. We report the cytological and histological findings of such a case in a 33 years old male, where the primary diagnosis of metastatic chondroblastoma was made on FNAC, which was later confirmed on histopathology. The present case highlights that, some chondroblastomas do exist, that are capable of pursuing a malignant course.

Ganglioneuromas, which are benign tumors of sympathetic nervous system, are rare to arise in adrenal gland. They are usually clinically silent and detected during work-up for other unrelated conditions. Currently, histopathology is the only tool to diagnose ganglioneuroma and to differentiate it from ganglioneuroblastoma and neuroblastoma. We discuss the case of a 40-year-old female found to have a right adrenal mass during investigation of dull ache in right upper abdomen. Clinico-radiological assessment was non-confirmatory on the nature of the mass, and excision was done. Histological examination showed the mass to be a ganglioneuroma arising in the adrenal gland. In conclusion, ganglioneuroma occurs rarely in adrenal gland and pre-operative diagnosis is difficult since the symptoms are usually non-specific. Histological examination is the mainstay of diagnosis and should be thorough to exclude neuroblastomatous foci, portending a worse outcome.

A 18 year young, healthy, immunocompetent girl presented with proptosis of left eye, referred to eye OPD, suspected clinico-radiologically as malignancy. This presentation with suspicion of malignancy resulted into extensive surgical debridement with removal of left eye, which was diagnosed as mucormycosis on histopathological examination. Her eye could have been saved if the mucormycosis was highly suspected initially, because of the good general health and immunocompetency led to misdirected thought.

Primary mesenteric liposarcoma is a rare malignant tumor of mesenchymal origin. These tumors are often found to be of substantial size upon first clinical presentation. We report a case of primary mesenteric liposarcoma in a 55 year old man who underwent laparotomy for the clinical/radiological impression of a mesenteric cyst. FNAC was inconclusive due to suboptimal cellularity. On laparotomy there were 2 masses (diameter- 19 and 14 cms) weighing approximately 8.5 kilograms together. Histopathology showed features of atypical lipomatous tumor / well differentiated liposarcoma (ALT/WDLS) with mixed histological pattern (e.g. lipoma like, sclerosing and myxoid areas) varying from area to area. Prognosis of ALT/WD liposarcoma depends upon its anatomic location and most aggressive histological subtype. This case is being presented because of its huge dimensions, rarity of the site and mixed histological pattern.

Symplasmic or atypical leiomyoma and lipoleiomyoma are two very rare morphological variants of leiomyoma of the uterus. Both the tumours show a benign behavior like the classical leiomyoma. But differentiated from the classical leiomyoma by presence of bizarre cellular pattern with paucity of mitosis and presence of mature lipocytes within a leiomyoma respectively. We report one case each of these variants in two routine fibroid uterus specimens of two different patients, as they can be misdiagnosed as leiomyosarcoma and well-differentiated liposarcoma respectively, by inexperienced pathologists.

Neurodegeneration with brain iron accumulation (NBIA), or Hallervorden- Spatz disease, is an extremely rare autosomal recessive disorder with cysteine-iron complex accumulation in globus pallidus, seen histopathologically. Magnetic resonance imaging offers an opportunity for diagnosis; however, therapeutic options are still ineffective. We report a case of 13-year-old girl, symptomatic since the age of three years with dystonia, poor scholastic performance and speech disturbances. She was admitted with aspiration pneumonia, and died before she could be investigated. Examination of brain at autopsy revealed iron deposition in bilateral globus pallidi, confirmed by special stains and elemental dispersion analysis by spectrometry and a diagnosis of Hallervorden- Spatz disease or NBIA was made. This report highlights the importance of autopsy and scanning electron microscopic examination in unsuspected cases where cause of death is not known.

Giant cell rich malignant fibrous histiocytoma accounts for 3 -15% of all malignant fibrous histiocytomas. Currently, the nomenclature giant cell malignant fibrous histiocytoma is reserved for undifferentiated pleomorphic sarcomas with prominent osteoclastic giant cells. It is considered to be synonymous with malignant giant cell tumor of soft parts. We report a case of disseminated giant cell malignant fibrous histiocytoma involving the scalp, cervical node, lungs, spine, abdominal wall, base of penis, gluteal cleft, paraspinal region and back. The diagnosis was established after staining for a panel of immunohistochemical markers namely cytokeratin, vimentin, S100, desmin, CD68 and smooth muscle actin. CD68 positivity in tumor cells helped in arriving at the final diagnosis. It is essential to recognize this tumor as a giant cell rich distinct entity and differentiate from other giant cell rich pleomorphic sarcomas since therapeutic and prognostic differences are being appreciated currently.

Plexiform schwannoma is a morphologically distinct and rare variant of schwannoma. It occurs most commonly in head and neck region and measures less than 2 cm in size. It is a benign tumor and malignant transformation has not been reported. We are presenting a case of plexiform schwannoma occurring on scalp and measuring 8cm in size because of its rarity and unusual size.

Pure fatty tumors of the uterus are exceedingly rare. The more common lipomatous tumor is lipoleiomyoma with varying amounts of two components. Most are post-operative chance findings following hysterectomy for leiomyoma. Computed Tomography and Magnetic Resonance Imaging can assist in pre-operative diagnosis. A 60 year old post-menopausal woman presented with a mass per abdomen. Ultrasound revealed fibroid uterus with lipomatous areas. The hysterectomy specimen showed a pure intramural lipoma of the uterus. As clinical symptoms and signs of uterine lipoma are indistinguishable from uterine leiomyoma, various imaging techniques can aid in pre-operative diagnosis. The diagnosis of pure lipoma of the uterus should only be made when any smooth muscle if present is confined to the periphery of the tumor.

Acardiac twinning is a rare anomaly .75% of cases occurring in monzygotic triplet pregnancies and the rest in monozygotic twins. We report an antenatally undiagnosed case of acardius amorphous. The condition results from abnormal placental vascular anastomoses termed as twin reversed arterial perfusion (TRAP) theory. Early sonographic prenatal diagnosis improves the survival of the normal twin called the pump twin.

Muir Torre Syndrome (MTS) is a rare syndrome complex of association of multiple sebaceous skin tumors with visceral malignancies. Till date a total of 205 cases have been reported in the world literature and to the best of our knowledge this is the first case report from the Indian subcontinent. Multiple, synchronous and metachronous, tiny sebaceous lesions is a hallmark of MTS along with multiple primary carcinomas at different sites, the commonest being gastro-intestinal tract cancers. The visceral cancers occur at a relatively young age. They are low-grade, non-aggressive and have a good prognosis. Awareness of this rare entity is essential. A case report of a 55-year-old male presenting with multiple sebaceous skin tumors, colonic cancer and positive family history in younger brother is presented.

A 56-year-old woman presented with gradually increasing lower abdominal lump since 1 year. She was subjected to laparotomy and a solid and cystic mass was removed from right broad ligament with pan-hysterectomy. Mass on histopathological examination was proved to be tumor of Wolffian origin. This is a condition rarely reported in Indian literature.

Syringomatous adenoma of the nipple is a rarely encountered neoplasm of the breast with histological features similar to eccrine syringoma of the skin. This tumour which is locally invasive with high potential for recurrence if incompletely excised is considered benign and a complete excision is sufficient. Hence it deserves recognition by pathologists and surgeons for appropriate management. We report a case of syringomatous adenoma of the nipple in a postmenopausal diabetic woman who was incidentally found to have a subareolar mass in her right breast. Clinical examination and mammographic findings indicated malignancy. Histopathological examination showed features of syringomatous adenoma of the nipple. A clinicopathological study and histological differential diagnosis of this unusual tumour is described.

Undifferentiated (embryonal) sarcoma of the liver is a rare primary malignant tumor of the liver occurring almost exclusively in childhood with characterisitic findings on gross and microscopy. Careful sampling of the tumor shows various immature undifferentiated elements and infiltration of the tumor into the surrounding capsule. CT findings could be suggestive of a hamartoma, as in our case. We report a case of hepatic embryonal sarcoma in a ten-year old male child presenting with an abdominal mass.

Poorly differentiated, spindle cell malignancies, on sun damaged skin frequently pose a diagnostic challenge for pathologists. The vast majority of these neoplasms ultimately are diagnosed as either atypical fibroxanthoma (AFX), spindle cell melanoma (SCM), and very rarely as spindle cell squamous cell carcinoma (SCSCC), leiomyosarcoma or angiosarcoma. Light microscopic clues may suggest one of these neoplasms, but subtle and overlapping characteristics often render precise diagnosis impossible based on morphological features alone. Immunohistochemistry therefore is necessary to firmly and accurately diagnose the majority of spindle cell malignancies on sun damaged skin. Aim of this case report is to highlight the practical approach to such diagnostic dilemmas.

Primary non-Hodgkin's lymphoma (NHL) of the breast is uncommon and the bilateral involvement is extremely rare. Usually, primary breast lymphoma is of B-cell phenotype, most common subtype being the diffuse large B-cell lymphoma. Preoperative differentiation of lymphoma from carcinoma is essential and limited material can pose diagnostic problem unless the index of suspicion is high. Twenty six year old pregnant lady, presented with bilateral breast lumps with a clinical impression of carcinoma. Fine needle aspiration cytology (FNAC) followed by biopsy of the breast mass was performed and a diagnosis of NHL, peripheral T-cell type (not otherwise specified) was made. She received 8 cycles of CHOP chemotherapy and showed dramatic improvement with regression of bilateral breast masses. She had an uneventful normal delivery and both the mother and the child are doing well. Since FNAC is a primary diagnostic tool for all breast lesions, a differential of lymphoma should always be kept in mind in all poorly differentiated malignant tumours. Such cases need biopsy confirmation and immunophenotyping for further sub-typing.

Well differentiated villoglandular adenocarcinoma of uterine cervix is a rare tumour which usually occurs in young women. It is considered to be an indolent tumour with favorable prognosis and most of them were treated by conservative procedures. We report a 35 year old lady who came with complaints of 3 months amenorrhoea and an episode of spontaneous bleeding. Urine pregnancy test was negative. Physical examination revealed a cervical polyp. Histopathological findings were consistent with villoglandular papillary adenocarcinoma associated with high grade cervical intraepithelial neoplasia (CIN-3). Left parametrial and left ureteral involvement, proved by biopsy, causing left hydroureteronephrosis was detected. The patient was thus found to be in an advanced stage, stage- III b (FIGO). The patient is currently undergoing radiotherapy. A review of literature showed that only occasional cases showing disease spread have been reported, suggesting caution in the management and regular follow up of the patient.

Blastomycosis is a chronic systemic fungal infection characteristically affecting the skin and lungs. Involvement of the central nervous system (CNS) is unusual, with cases generally presenting with meningitis, and rarely as intracranial mass lesion and solitary or multiple abscesses. Only two cases of intracranial extra-axial blastomycosis have been reported from India, and we report the third case, which presented as meningioma in a 23-year old female.

Steatocystoma multiplex is an autosomal dominant condition, though sporadic cases are also known, as in our cases. It is characterized by the presence of multiple non tender cystic nodules over the body, exuding syrupy fluid when excised. The lesions are usually seen around puberty and we present here two cases in middle aged with no family history of similar presentation.

Proliferative lesions of specialized prostatic stroma are rare with only few isolated case reports documented in literature. These lesions are histologically characterized by exuberant proliferation of prostatic stroma with variable number of normal and hyperplastic glands. Recently this group of tumors have been labeled as prostatic stromal proliferations of uncertain malignant potential (PSPUMP). We report a case of PSPUMP in a 72 years old male who underwent radical prostatectomy for a mass in pelvis. Based on histological appearance and immunohistochemistry, a diagnosis ofPSPUMP was made.

Portopulmonary hypertension (PPHT) is the unusual association of portal hypertension (HT) with pulmonary HT. We report a case of noncirrhotic portal fibrosis (NCPF) leading to PPHT which is exceedingly rare with only very few cases reported in the literature. This is an autopsy report of a 30 years old man, a known case of portal HT who died suddenly due to a syncopal attack. Autopsy revealed massive pulmonary thromobembolism with pulmonary HT. Liver showed changes of NCPF. The rarity of NCPF causing PPHT prompted this case report.

Calcifying fibrous pseudotumor with psamomma bodies (CFT) is a distinct soft tissue lesion characterized by lymphoplasmacytic collections in a rich collagenous background with abundant calcification. It was recognized first in peripheral axial soft tissues. Recently reports of this lesion in an intrabdominal location have raised speculations about it being a myofibroblastic tumor. However, this has been discounted on several objective grounds. Its recognition is important for the excellent prognosis, once adequately excised. This case report exemplifies one such case with a long-term disease-free follow-up and discusses the other clinicopathologic entities it may be confused with.

We report a 50 year old male who presented with a short history of gross hematuria. An ultrasonogram detected a mass arising from the right lateral wall of the urinary bladder. Computed tomography of the abdomen revealed that the mass was a calcified lesion mimicking a bladder stone. Cystoscopy confirmed the presence of the calcified lesion and biopsy revealed a rare biphasic tumor of the urinary bladder comprising of osteosarcoma and a papillary urothelial neoplasm of low malignant potential. The rarity of this tumor and its associated exuberant calcification make this case an interesting one.

Cellular schwannomas in pharyngeal region are rare. These tumors histologically mimic malignant peripheral nerve sheath tumors because of their growth pattern, high cellularity and mitotic activity, but they are relatively benign tumors with a tendency to recur but do not metastasize.

Testicular fine needle aspiration cytology (FNAC) is an important investigation in management of male infertility, especially to differentiate between obstructive and non obstructive causes of azoospermia. It is less invasive and associated with no or minimal complications. Nowadays when assisted fertilization techniques are being practiced, fibrosis after biopsy may further hamper in sperm extraction for intra cytoplasmic sperm injection (ICSI). Present study describes a detailed analysis of aspiration cytology in 546 cases and also compared 48 cases of testicular biopsies with cytology. The cytological diagnoses correlated well with histological diagnoses and helped in management of infertility. FNAC can help in management of surgical and medical causes of infertility and can save unnecessary expensive investigations in cases of sertoli cell only syndrome and atrophic patterns. FNAC in combination with semen analysis and serum follicle stimulating hormone levels are of great help in management of male infertility.

This study was undertaken to highlight the use of fine needle aspiration cytology (FNAC) to distinguish tumours metastatic to the breast from primary breast malignancies. A total of 1866 fine needle aspirates of the breast were performed during a period of 7 years. Three hundred and fourteen cases of breast malignancies were diagnosed and 5 (1.5%) out of these cases were metastatic in origin. The metastatic tumors included, 2 cases of malignant melanoma (chest wall and left arm), 1 case each of haematolymphoid malignancy, adenocarcinoma of the ovary, and squamous cell carcinoma (left leg). FNA diagnosis of metastasis to the breast is essential in order to avoid unnecessary mastectomy and to ensure appropriate chemotherapy and/or irradiation treatment.

Hürthle cell neoplasms (HCN) are an uncommon group of tumors of the thyroid gland. Fine needle aspiration cytology (FNAC) is an important diagnostic tool in solitary nodules of the thyroid gland. A 5-year retrospective analysis of all cases diagnosed as HCN on cytology was performed and correlated with the corresponding histopathology wherever available. There were 13 cases diagnosed as HCN out of which 6 cases had subsequent histopathologic examination. Four were adenomas and two were carcinomas. In addition, 3 cases that were adenomas on histopathology were reported on cytology as colloid goiter with cystic degeneration in 2 cases and as follicular adenoma in 1 case. There was extensive cystic degeneration in the former two cases whereas poor cellular preservation led to misdiagnosis in the third case. There were no specific cytomorphological features that distinguished adenoma from carcinoma. FNAC has a high specificity for a diagnosis of HCN, but the sensitivity is not as high because of sampling error.

The study was undertaken to determine the accuracy of cytological diagnosis of CNS lesions by comparing it with the final histopathological diagnosis of CT guided stereotactic brain biopsy. Squash preparations were prepared from 25 cases of CNS lesions operated in two years. These included 18 astrocytomas, 1 metastatic deposits, 1 epidermoid cyst, 1 Toxoplasmosis, 1 granulomatous inflammation and 3 cases showing normal brain parenchyma. The cytological diagnosis was available to the neurosurgeon within 10 minutes. The cytohistological correlation with paraffin block sections worked out to be 92%. Thus, this proved to be a fairly reliable and rapid method for immediate intra-operative diagnosis.

Secretory carcinoma (SC) of the breast is an extremely rare neoplasm, often associated with a very good prognosis. It is still rarer in adults, where it is potentially more aggressive than in childhood. The present case refers to a 52 year old female with a progressively growing lump in the right breast. The cytological and histopathological findings were characteristic of secretory carcinoma. The differential diagnoses are discussed and the pertinent literature is reviewed.

A 50 year old female had a myxoid liposarcoma of left thigh that was widely excised. After three years, she presented with a soft tissue mass in right hypochondriac region, which was diagnosed as myxoid liposarcoma on fine needle aspiration cytology (FNAC) and was confirmed histologically.

The cytomorphology of skin adnexal tumours has not been described extensively in literature. We report the first case of trichofolliculoma, a hair follicle hamartoma, which was subsequently diagnosed by excision biopsy. A 19 year old woman presented with a nodule on the dorsal aspect of the finger which was clinically suspected to be a myxoid cyst. FNA showed several cohesive as well as arborising branched groups of squamous cells with evidence of keratinisation. The background had dispersed and loosely clustered sebaceous cells. The excision biopsy revealed a trichofolliculoma. Cytology is a useful tool in the diagnosis of skin adnexal tumours. The finding of cohesive, branching keratinized squamous cell clusters admixed with sebaceous cells may suggest a diagnosis of trichofolliculoma, as was seen in the present case.

A 62-year-old man presented with rapidly growing tumour in the right parotid region with associated pain and facial nerve palsy. Based on the fine needle aspiration cytology report of high-grade mucoepidermoid carcinoma, parotidectomy was performed which showed features of salivary duct carcinoma. The smears were reviewed to identify the potential pitfalls in the cytological diagnosis of salivary duct carcinoma.

Inflammatory myofibroblastic tumour formerly also known as inflammatory pseudotumour, was recognized initially in the lung and has been described in other visceral organs. It's occurrence in the subcutis is not well documented and its cytological appearance may be misinterpreted as malignant. This is the first case report of inflammatory myofibroblastic tumour of the subcutis in pediatric age group. A 12 year old female child presented with a subcutaneous swelling in the left anterior chest wall. FNA was performed and the cytological appearances were interpreted as malignant. Histopathology and immunohistochemistry revealed an inflammatory myofibroblastic tumour of the subcutis. FNA cytology is not very helpful in distinguishing inflammatory myofibroblastic tumour from malignant lesions especially soft tissue sarcomas. Awareness of it's occurrence in the subcutis is of importance for it's proper identification and treatment.

Primary cutaneous lymphoma designates a heterogenous group of disorders arising from skin T and B cells with no evidence of extra cutaneous disease at the time of diagnosis and six months thereafter. We report the cytomorphological features of a case of primary cutaneous lymphoma, B cell type in a 60 year old female presenting with multiple large bosselated red coloured swellings all over the scalp. Clinical examination revealed no other swelling or lymphadenopathy. On cytology a diagnosis of B-cell cutaneous lymphoid hyperplasia (B-CLH) was given, however cutaneous lymphoma could not be ruled out. On biopsy and immuno-histochemistry a diagnosis of primary cutaneous lymphoma B cell type was made. Patient was started on specific chemotherapy of lymphoma to which she responded completely. Here we highlight the cytomorphologic, histopathological and immunohistochemical features of this rare lesion with a particular emphasis on the diagnostic dilemma encountered on cytology.

Despite many studies on non-HLA genetic polymorphism its role in transplantation is still not well understood. The NK cell receptor gene, MICA gene and Minor histocompatibility (mHag) system makes the puzzle still more intriguingly complex. Studies on cytokine gene polymorphism have enlightened some interesting associations such as the effect of donor IL-6 genotype on acute rejection in renal transplantation. In the bone marrow transplant where each polymorphism is taken as a risk factor for GVHD necessitates prospective testing of non-HLA gene polymorphism and hence, transplant outcome. Various typing methods are now available to identify the non-HLA genetic polymorphisms. A scenario can be envisaged where polymorphisms associated with transplant outcome are tested prior to transplantation at the same time as HLA typing.

Pediatric small round cell tumors (SRCT) are a group of neoplasms occurring in children, which have in common a cytomorphology of groups of small round cells with scanty cytoplasm. The common SRCT encountered are neuroblastoma, retinoblastoma, Ewing's sarcoma/peripheral neuroectodermal tumor (PNET), rhabdomyosarcoma and lymphoma which show varying degrees of bone marrow involvement and bone marrow evaluation forms a part of the initial staging procedure. This study was undertaken to evaluate marrow involvement at presentation in pediatric non hematological SRCT. 7833 bone marrow aspirates done over a period of three years in different malignancies were analysed and of these 180 aspirates were performed in patients of pediatric non hematological SRCT at presentation. These cases were evaluated in detail for incidence of marrow involvement. Thirty two (17.7%) cases showed marrow involvement and these cases have been analysed with respect to the primary tumor. The SRCT showing involvement of bone marrow included neuroblastoma (48.8%), retinoblastoma (11.1%), Ewing's sarcoma/PNET (8.6%) and rhabdomyosarcoma (3.2%).These findings are discussed in the light of available world literature.

In the recent years, male infertility and subfertility has increased, which is attributed to many factors. So our study focuses the effects of age, occupation, smoking, alcohol and varicocele on the semen quality. Detailed history and examination of 93 cases (fulfilled inclusion criterion) was done. Semen analysis of these cases were compared with above parameters using statistical tools like mean, standard deviation, standard error of mean and significance was tested by student's 't' test. The mean sperm density, total motility and rapid progressive motility in control group were 68.95 x 10(6)/ml, 59.9% and 30.5% respectively. Reduction of sperm density was statistically significant (p value < 0.05) in both tobacco users + alcoholics and in varicocele patients in comparison with controls. Age and occupation did not alter semen quality significantly. Our study concluded that semen quality is decreasing in the past few decades and combined tobacco + alcohol use, and varicocele have more detrimental effect on semen quality.

Acquired Immune Deficiency Syndrome (AIDS) is one of the serious public health problems in India. AIDS education has been considered as one of the main intervention for control. Sexual route is the major route of transmission of Human Immunodeficiency Virus (HIV); however, approximately 2.5% is transmitted through blood and blood products. The present study was carried out to know the level of awareness about HIV infection and blood donation among first time (190) and repeat (310) voluntary donors of all age groups. One pre-structured questionnaire was circulated among altruistic blood donors. About 96.6% donors want to become repeat donors. Majority of the donors had good knowledge about routes of HIV transmission. According to 97.4% donors, it is transmitted by sexual route, according to 87.4% of donors by sharing needle, according to 85% of donors by blood transfusion and 82.4% of donors believe through vertical transmission. However, 32.4% of the donors, still believe that HIV infection could be transmitted through blood donation. Intense motivational program among donors is needed to remove this myth. Regular donors were convinced the importance of regular and repeat blood donation. They came forward to donate blood for the cause of humanity (80.6%) and the sense of pride (27.79%). First time donors were less motivated by the cause of humanity (56.21%) and volunteered because of peer pressure (26.03%) and motivated by relative or friend. Donors were very alert about precaution to be taken for protecting themselves from danger of HIV infection and priority wise use of safe sexual practice (90%), disposable needles (61.43%) and receive tested blood (45.71%) whenever required. When in need of blood for relatives the donors will give priority to the quality (64.65%) and properly tested blood from voluntary blood donors (86.7%).

Sickle cell anaemia is a common and widespread haemoglobinopathy with large clinical heterogeneity. The present study, was undertaken to determine seven different haematological parameters (Haemoglobin percent, RBC count, PCV, MCV MCH, MCHC, Reticulocyte count) on total 102 heterozygous (SA) and homozygous (SS) sickle cell children under six years of age. In addition, fetal haemoglobin (HbF) level was estimated in SS children and correlated with clinical status, gender and ethnic background. Mean HbF was 16.79%. Higher HbF level was associated with less severe clinical feature. HbF was not influenced by gender and ethnic background. In homozygous children mean values of MCV, MCH, MCHC were decreased while reticulocyte count was increased as compared to control (AA) children and (SA) children (P < 0.05) We conclude that, in sickle cell disease, HbF was a good prognostic indicator. Higher HbF level along with microcytic hyopochromic indices and lower MCHC was found to be a feature of the study population.

A decrease in CD4 counts in HIV positive patients with concomitant tuberculosis leads to an increase in the morbidity and mortality. Little data exists about the use of antiretroviral drugs along with antitubercular drugs on the improvement in CD4 counts from this part of country. The records of 119 HIV and TB positive patients were obtained from immunodeficiency clinic of tertiary care centre of North India who were on drug treatment for both the diseases and were analysed for demographic profile and effects on CD4 counts. There was a statistically significant improvement in the CD4 counts of the patients as compared to their baseline values mean (SD) as 120.03 (124.1) at visit one to 270.2 (141.3) at visit two (p < 0.01) and 320.9 (184.3) at visit three (p < 0.05). Six patients died during the period of evaluation. Concomitant use of antitubercular drugs with antiretroviral drugs has resulted in a significant improvement in the CD4 counts which is a marker of delay in disease progression.

Seronegative Spondyloarthropathies (SSA) is a very common problem in our area. The main aim of present study was (1) to find the HLA B27 positivity in patients presenting with sacroileitis (2) to see the correlation of B27 positivity on haematological, radiological and extra articular manifestations. Total 110 patients of SSA were studied between July 2004 to June 2005. Routine haematological and immunological test were done by standard method. Total positivity of B27 in SSA was 43.63%, HLA B27 positivity was higher in children (68.75%). Sex wise analysis of B27 positive cases showed that 81.81% B27 positive patients were males. In HLA B27 positive cases lower spine, hip, sacroiliac, shoulder and knee joints were more involved (77.08%, 79.16%, 79.16%, 37.50% and 50.00% respectively). Urinary tract infection (UTI), diarrhoea and constipation were more common in B27 positive cases. Leukocytosis of neutrophilic type (33.33%), raised ESR (77.55%)., CRP positivity (63.63%) and anaemia (65.00%) were seen more frequently in B27 positive cases. In bilateral sacroiliitis diagnosed by X-ray, only 69.23% patient were B27 positive. Our study concludes that HLA B 27 positivity is higher in SSA seen in childhood and in young adult males. B27 positive patients have more severe disease and systemic manifestation Hence, male patients specially young adolescent or young adults with sacroileitis must be subjected for B27 typing.

Mortality in sickle cell disease is high at young age group. So it is necessary to find out the cause of death in young patients with sickle cell disease. We are presenting 5 cases of sudden death in young adults with undiagnosed sickle cell disease. The provocative factors for those terminal events were vasoocclusive crisis. In our patients crisis was secondary to fever (infection), conductive arrhythmia, cardiovascular collapse, post partum shock and hemorrhage. On microscopic examination of viscera, not a single patient showed signs of chronic organ damage, sequestration crisis or acute chest syndrome, which are the common causes of death in sickle cell disease.

Non-hematopoietic malignancies infiltrating bone marrow have always been a source of erroneous diagnosis. Among these, the small round cell tumors like neuroblastomas and rhabdomyosarcomas mimick the hematopoietic blasts. Several case reports of rhabdomyosarcoma mimicking acute leukemia, clinically and morphologically at presentation have been reported in the literature. To the best of our knowledge such an entity has not been reported in Indian literature. We report here one such case of alveolar rhabdomyosarcoma masquerading as acute leukemia. A thorough clinical examination with high degree of suspicion on bone marrow morphology and judicious use of appropriate immunohistochemistry markers will solve many of these cases.

Bombay phenotype is unique in the aspect that the red cells are not agglutinated by antisera A, B and H. However the serum of such individuals contains anti A, B and strongly reactive anti H which agglutinates red cells of 'O' group individuals through a wide thermal range. The blood specimen of a 35 year old male donor who donated blood for the first time was subjected to detailed cell and serum grouping. There was a discrepancy between the results. The possibility of Bombay phenotype was considered and the sample was tested with anti H lectin. Further confirmation of blood group and secretor status was done from a reference laboratory. Family studies showed the same blood group in the elder sibling of the propositus. The present case highlights the significance of correlating cell and serum grouping results. Moreover, this blood group is very rare in North India. Family studies revealed the propositus to possess the B gene which was suppressed in the donor but expressed in the offsprings. The use of anti H in discrepant blood grouping results is recommended.

Multi drug resistant Pseudomonas aeruginosa (MDRPA) and pan drug resistant Pseudomonas aeruginosa (PDRPA) isolates in critically ill patients are often difficult to treat. Prevalence of MDRPA and their antibiotic profile was investigated to select an appropriate empirical therapy. Moreover lack of sufficient data on prevalence of PDRPA in tertiary care hospitals indicated the need for this study. Pseudomonas aeruginosa was isolated in 245 patients over a period of one and half years from various clinical materials and their antibiotic profile was determined. Minimum inhibitory concentration (MIC) for Imipenem and Meropenam was determined by broth dilution method. Phenotypic confirmation test and EDTA double disk synergy test was used to detect Extended spectrum a-lactamase (ESBL) and Metallo-a-lactamase (MBL) producers respectively. Out of 245 isolates, 54 strains (22 %) and 11 strains (4%) were found to be MDRPA and PDRPA respectively. Carbapenem resistant isolates showed MICs ranging from 16 to > 64 microg/ml. Thirty eight strains (15.5%) were ESBL producers and six (54.5%) among 11 PDRPA were MBL producers. Prevalence of MDR and PDR isolates of Pseudomonas aeruginosa was found to be 22% and 4% respectively, which is less compared to other studies. Majority of the PDRPA isolates were MBL producers which have propensity to spread to other bacteria.

A total of 14555 serum samples collected between January, 2001 to April, 2006 were screened for HIV infection. Antibodies to HIV-1/ HIV-2 were present in 985 (6.76%) of which 964 (97.86%) and 2 (0.22%) were positive for HIV-1 and HIV-2 alone respectively and 19 (1.92 %) for both HIV-1 and HIV-2. Of the 21 in whom HIV-2 infection was detected (alone and dual), 19 (90.5%) were in the age group of 21-40 years and 2 were children below the age of 11 years. Predominantly mode of transmission in them was heterosexual (85.71%) while the 2 children (9.53%) had most probably got the infection through perinatal route. Nine (42.85%) were asymptomatic and 12 (57.15%) clinically presented with chronic diarrhoea (5), prolonged fever (4) and symptoms related to sexually transmitted diseases (3). Opportunistic infections like Oral candidiasis was observed in 3 and pulmonary tuberculosis in 2.

A rare case of Acanthamoebae meningoencephalitis is diagnosed in cerebrospinal fluid (CSF) of a 24 years old male suffering from acquired immunodeficiency syndrome (AIDS) patient on the basis of bright field microscopy and culture growth on non-nutrient agar with Escherichia coli. This case illustrates that Acanthamoebae should be considered in the differential diagnosis of meningoencephalitis in AIDS in addition to tuberculosis and cryptococcus infection in tropical areas.

Fungal ball caused by Aspergillus species is an opportunistic infection. We describe a case report of a patient with culture positive Aspergillus fumigatus who presented with complaints of cough and expectoration with recurrent episodes of haemoptysis. Tuberculosis is the commonest cause of haemoptysis in India. However fungal ball is also one of the leading cause of haemoptysis. Hence laboratory evaluation of haemoptysis should not only include work up for tuberculosis but sample should also be submitted for mycological evaluation.

We report two atypical presentations of melioidosis as mediastinal lymphadenitis and prostatic abscess with Burkholderia pseudomallei, the emerging category 2 organism which led to diagnostic and therapeutic dilemma and thereby, delay in appropriate management. Any similar presentation should always be supported by microbiological opinion without any delay, which can help in instituting proper antibiotics with successful outcome.