Indian Journal of Pathology and Oncology

483-488

Authors: Athiyamaan MS, Hasib AG, Sridhar CH, Sudhir Prabhu

Introduction: CT number (CTN) for the gross tumour volumes (GTV) can change with radiation therapy which could be an early indicator for radiation response. This study investigates the correlation of radiation induced changes in volume and CTN in GTV of primary and nodal tumour during the course of intensity modulated radiation therapy (IMRT) in head and neck cancers (HNC). Materials and Method: Re-CT scans were acquired at 4 weeks for 71 patients with stage II- IVb HNC treated with chemoradiation. The changes in volumes and CTN of the GTV primary and GTV node at 4 weeks of radiation were observed. Pearsons’s correlation were used to assess any correlation between CTN change and volume reduction of the GTVs. Results: The volumes of the GTV Primary and GTV Node were reduced during the course of the radiation therapy after 4 weeks with mean volume shrinkage of 26.30±7.66(p<0.0001) and 32.09±37.2(p<0.04) respectively and the mean CTN reduced by 2.50±5.4 and 1.79±4.12HU’s respectively. The CTN and GTV volume decreases were found to be positively correlated (GTVP >GTV N) though the relationship is weak. Conclusion: The CTN changes in GTV P and GTV N during delivery of radiation for HNC is measurable and are patient specific. The volume reduction is observed more in GTV N where as CTN reduction is noticed in both GTVs with a reasonable correlation between the mean CTN and volume reductions in GTVs.

495-500

Authors: C. Jayanthi, Lavanya M, G. Rajesh Kumar, SP Arun Kumar.

Introduction: Helicobacter pylori(HP) infection is a major cause of various gastroduodenal pathologies. The objective of our study is to evaluate various histopathological parameters of chronic gastritis using the updated Sydney system and to correlate it with presence of HP. Materials and Method: Total 250 cases of chronic gastritis was evaluated retrospectively from January 2015 to December 2015 in a tertiary care centre. Histopathological examination of all antral gastric biopsies using Hematoxylin and Eosin, and Giemsa stain for grading of various parameters and for detection of HP was carried out. Result: Chronic inflammation was identified in 100% of cases with varying intensity. Intensity of activity showed an incremental trend with density of HP. Forty percent of cases with intestinal metaplasia showed the presence of HP. Atrophy was documented in only one case. A strong association between chronic inflammation, activity, intestinal metaplasia and lymphoid follicle with HP was established. Conclusion: The updated Sydney classification provides an objective mean of classifying chronic gastritis and increases the likelihood of detection of HP. Presence of intense grade of inflammation, activity and lymphoid follicle should hint the histopathologist to search for HP. And also the presence of one of these features is a strong indicator for the presence of the other.

507-510

Authors: Manika Kundra, Hemapant

Introduction: The effect of age on histopathology of the urothelial and non-urothelial bladder tumors has not been studied extensively in literature. This study was undertaken to gain knowledge about this aspect. Materials and Method: A four year retrospective study, from January 2013 to December 2016 of bladder tumors was carried out in the department of pathology, Sri Ram Murti Smarak institute of medical sciences, Bareilly. The biological material came from TURBT specimens from patients hospitalized for bladder tumors in our institute. Results: Of all the bladder tumors studied, urothelial tumors comprised 95%. A total of 172 urothelial tumors were detected in age category 40 years and above, as compared to 18 in age category below 40 years. Out of all the urothelial tumors in age category 40 years and above, 65.5% tumors were invasive. In age category 40 years and below, such tumors were 46.6%. All the non-urothelial tumors were detected to be histopathologically invasive and were nine times more common in above 40 year age category than in 40 years and below age category. On studying the non-urothelial variety of bladder tumors we detected that all of them were invasive histopathologically. Besides, these non-urothelial variety of bladder tumors were nine times more common in age group 40 years and above than in age category 40 years and below. Conclusion: The incidence of bladder tumors of both urothelial and non-urothelial varieties is significantly lower in patients less than 40 years.

517-522

Authors: K. Shashikala, Gandhi N, Akansha Shukla, Ashwini Rathore.

Introduction: Endometrial aspiration cytology is a diagnostic modality for studying cyto-harmonal changes and for evaluating endometrial pathology ranging from inflammatory changes, hyperplasia and endometrial malignancies. Aims: To assess the diagnostic accuracy of endometrial aspiration technique and to compare the cyto-morphology of aspirated smears with histopathology. Materials and Method: Endometrial aspiration was performed using Karman’s cannula in 100 cases who presented with abnormal uterine bleed, infertility and postmenopausal bleed. The endometrial specimens obtained by D& C were processed and evaluated histologically. The endometrial aspirated smears were correlated with histopathology findings for diagnostic accuracy. Results: The study cases included 48 patients in reproductive age group and 52 patients in the perimenopausal and postmenopausal age groups. The diagnostic accuracy on cytology was 90% when compared to histology. The smears were inadequate for reporting in eight cases. The sensitivity of endometrial cytology was 93% and specificity was 85.7%. Conclusions: Endometrial aspiration technique with Karman’s cannula is convenient, simple, safe and less invasive procedure. The endometrial aspiration cytology proved to be effective diagnostic modality in the interpretation of normal and abnormal endometrium. The present study emphasizes the need for early screening to diagnose pre-invasive lesions and endometrial malignancies in peri-menopausal and post-menopausal patients.

529-532

Authors: Anushree CN, Reshma Devani, HT Jayaprakash.

Register Introduction and Objective: Thyroid gland lesions are seen worldwide with geographical variation in incidence and histopathological pattern related to age, sex, dietary and environmental factors. This study is aimed to describe the histomorphological spectrum of thyroid lesion in relation to age, sex distribution and also to compare the findings with other studies done in India and elsewhere. Materials and Method: It is a prospective study of all thyroidectomy specimens received from June 2015 - Dec 2016 in department of pathology, Dr. B R Ambedkar Medical College, Bengaluru. Results: A total of 100 cases were studied. Female to male ratio was 6:1. The age group ranged from 12-75yrs with peak incidence seen at 35-45yrs. The lesions were classified as non-neoplastic and neoplastic. Non-Neoplastic lesions were more common and accounted for 82% and neoplastic lesions accounted for 18%. The most common lesion was goiter (68%), followed by thyroid adenomas (16%) and thyroid carcinomas (2%). There were 7 cases of toxic goitre (7%), 4 cases of thyroglossal cyst (4%) and 3 cases of thyroiditis (3%). Conclusion: The study shows that thyroid gland diseases are seen in both genders with female preponderance. Among the varied histomorphological spectrum of surgical lesions of thyroid, colloid goiter is the most common lesion. Follicular adenoma is the commonest benign tumor and a higher incidence of follicular carcinoma was seen.

536-539

Authors: Chitturi Ramya, IV Renuka, P. Premalatha, K. Madhavi.

Introduction: Routine semen analysis remains the backbone in the evaluation of male factor infertility, besides detailed medical history and thorough physical examination. Male factor is responsible in at least 50% of cases of failure to conceive. Aims and Objectives: To evaluate the seminal patterns in male partners of infertile couples and to identify possible contribution of male factors to overall infertility problem. Materials and Method: Ours is a retrospective study of all semen samples collected from 1st July 2015 to 30th June 2016. Various Seminal parameters were evaluated like volume, pH, liquefaction time, viscosity, pus cells, sperm count, motility and morphology according to WHO (World Health Organization) criteria. Results: There were total 159 cases. The age ranged from 20yrs to 43yrs.The most common abnormalities found in our study were oligozoospermia and azoospermia. Conclusion: Semen quality remains a significant contribution to overall infertility. Semen analysis is still a cornerstone laboratory evaluation and contributes to defining the possible male factor to a couple’s infertility.

546-550

Authors: Savita M. Sonawane, Sheela L. Gaikwad, Rutuja U. Londhe

Introduction: Fine needle aspiration cytology (FNAC) is well accepted as a useful diagnostic technique in the management of adult patients with swellings. Until recently the application of FNAC to the pediatric population was largely ignored in the Indian and American pediatric literature. There are only few Indian studies of FNAC in pediatric population. Previous reports have studied its utility mainly in head and neck lesions, lymphadenopathy, malignant neoplasms of a particular organ in pediatric population. Materials and Method: The present study was carried out in a rural tertiary care hospital over a period of 30 months in patients attending the out-patient departments of the hospital presenting with masses and or associated symptoms. It comprises of 148 fine needle aspiration cytology smears aspirated from children of age group 1-14years. Conclusion: Even though childhood tumors share common cytological features, the diagnosis can be narrowed down to particular type with the help of clinical and radiological features. FNAC can be recommended as a first line investigation in diagnosis of pediatric lesions and is also an effective method for evaluation and primary diagnosis of lesions in pediatric population.

555-559

Authors: G. Patil Anuradha, AM Anita, Saini Kr. Seemant, S. Pratima.

Introduction: Today appendicitis remains the most common indication for emergency laparotomy, especially in the young. Mast cell is one of the most important cells of inflammation and acute appendicitis is triggered by Type -1 hypersensitivity reaction and infection is later consequence. Materials and Method · In the present study mast cell number & distribution in surgically resected appendix were studied to see variation in normal & inflamed appendix, in Department of pathology Mahadevappa Rampure Medical College, Kalaburagi. · 180 appendicectomy specimen received from Oct 2015 to Oct 2016.Routine Hematoxylin & Eosin section for histopathology and 1% aqueous toluidine blue was used to study mast cells. · These cases were divided into two groups, Group A: Acute appendicitis showing neutrophilic infiltration- Group A1, with eosinophilic infiltrate- Group A2 Group B: Chronic appendicitis showing lympho mononuclear infiltrate and fibrosis. · Mast cells were counted in 10 consecutive high power fields and number were assessed and recorded semi-quantitatively. Results: There is variation in mast cell counts in appendicitis as observed in present study. In acute appendicitis, mucosal and sub mucosal mast cell counts were decreased. Eosinophilic appendicitis showed increased number of eosinophils in mucosal and sub mucosal layer but mean mast cell counts were decreased. In chronic appendicitis was excessive lympho mononuclear infiltrate in mucosal and sub mucosal layer & mean mast cell counts were highest. Conclusion: Our study concluded that acute appendicitis is IgE mediated type 1 hypersensitivity reaction and mast cells count showed variations in different form of appendicitis.

564-569

Authors: Amritha Malini G, Rajeevan K, Ajith Kumar VT, Sathi PP, Aravindan KP.

Introduction: Prognostication of acute leukemia by detecting immunophenotypic marker expression on leukemic cells by flow cytometry is crucial in providing individualized treatment and improving outcome in Pediatric ALL (Acute lymphoblastic leukemia). The Aim of the study was to determine whether expression of CD34 and CD10 could be used as additional prognostic markers in predicting treatment response in Pediatric ALL cases. Materials and Method: This study was conducted among 44 pediatric ALL cases diagnosed in 2 year period in a tertiary care centre in North Kerala. Peripheral smear (PS), & bone marrow (BM) were examined, clinical and laboratory parameters were studied and flow cytometry was done in all cases and expression of CD10 & CD34 were noted. Treatment response was assessed by examining peripheral smear on day 7 after treatment, BM after induction, Cerebrospinal fluid (CSF) examination during induction phase .All the cases were followed up. Result: In our study it was observed that presence of blasts on day 7 peripheral smear and CSF were more in CD34 negative cases compared to CD34 positive cases. BM remission after induction, treatment response and good outcome on follow up were more among CD34 positive cases. The results were statistically significant for CD34 expression. CD10 expression alone was not found to be statistically associated with treatment response. Conclusion: CD34 expression predicts treatment response and is a significant favourable prognostic factor in pediatric ALL cases. It can be included in risk stratification for planning treatment along with established parameters.

575-579

Authors: E. Jayashankar, P. Shailaja, PN Jikki, T. Ramamurti, AK Deshpande.

Introduction: Renal biopsies are very important in diagnosing and managing children with renal diseases. There are few studies which highlight the histological pattern of renal diseases in pediatric age group. Objective: This study was conducted to analyse indications for renal biopsies, and also histological pattern of renal diseases in children which were referred to the Pathology department, Kamineni Hospitals, Hyderabad by the Nephrology department, Government General Hospital, Kurnool. Materials and Method: A retrospective analysis of kidney biopsy reports from December 2013 to December 2016 was done. Adult biopsies, inadequate and renal allograft biopsies were excluded from the study. Only pediatric age group of 1-14 years was considered. Results: Out of total 750 biopsies, 130 cases belong to pediatric age group. Male to female ratio is 1.8:1, with a mean age of 10 + of -4. Nephrotic syndrome is the most common indication for renal biopsies and histologically minimal change disease (MCD) is the most common (43%) histological pattern followed by membranoproliferative glomerulonephritis (MPGN) (18%), focal segmental glomerulosclerosis (FSGS) (11%), and Post infectious glomerulonephritis PIGN (10%) etc. Conclusion: Nephrotic syndrome is the most common indication for renal biopsies and MCD is the most common type of glomerulonephritis among pediatric cases diagnosed at our institution.

586-590

Authors: Rupali Patil, Vandana Patel, Minesh B. Gandhi.

Introduction: There are many blood group systems to classify red blood cells based on the presence of inherited antigens on their surface. Blood group antigens are inherited antigens and they already appear early in intrauterine life and remain constant through out life. Out of all antigens, two most important antigens are ABO and Rh antigens and they mostly found on RBCs surface and on platelets in blood. The human blood groups were first discovered by scientist Karl Landsteiner in 1901. ABO and RhD testing is the most frequently performed test in blood banking. Aims and Objectives: To know the distribution frequency of other blood groups in healthy and adult blood donor, to compare this study data with other study data in other states of India and all over the world and to make documentation of a blood group data registry. Materials and Method: Present study was conducted at Gujarat Medical Education and Research Society Medical College attached General Hospital, Gandhinagar, a tertiary care teaching Gujarat Government hospital. All blood donors were done counselling as per NACO guidelines and considered fit for blood donation were included in this study. Total 6853 blood donors were considered physically screened and declared fit and accepted for blood donation. Results: Out of the total 6853 blood donors, 6508 (94.97%) were males and 345 (5.03%) were female and 6504 (94.9%) donors were of Rhesus ‘D’ positive and 349 (5.1%) were of Rhesus ‘D’ negative. In present study, blood group B was found to be the commonest blood group. Conclusions: Female blood donors were very low because their haemoglobin level was below the required criteria and this needs to be increased by high quality of food and health status. The blood group of each and every person must be indicated on their driving licenses, aadhar card, PAN card and school/office identity cards. This study is most important for management of blood bank inventory and transfusion services to the needy patients.

595-599

Authors: Maithili Mandar Kulkarni, Siddhi Gaurish Sinai Khandeparkar, Avinash R. Joshi, Sukhada R. Patil, Pra.

Introduction: Arthritis, an important cause for morbidity, is commonly found in clinical practice. Diseases such as tuberculous synovitis and gout need treatment directed towards specific diagnosis which can be achieved by the use of relatively simple technique of arthroscopic synovial aspiration and biopsy. Aim and Objectives: To study the histomorphological spectrum of different clinically suspected synovial lesions and to assess diagnostic utility of synovial biopsies. Materials and Method: The present study comprises analysis of 100 biopsies of clinically suspected synovial lesions during period of 4 years. Relevant clinical details were obtained. Synovial biopsy specimens were processed routinely and wherever necessary special stains like Z-N stain for AFB, Prussian blue stain for haemosiderin and immunohistochemical studies were carried out.. Wherever necessary the available clinical and radiological findings were taken into consideration to categorize the lesions. Lesions were classified under main categories of inflammatory joint diseases, degenerative joint disease, tumor and tumor like conditions. Results: In our study, the common age groups affected were between 40-60years. Both sexes were equally affected. Most common symptoms were pain and swelling. Knee was the commonest joint involved. Most common histopathological diagnosis made among the clinically suspected synovial lesions was chronic nonspecific synovitis followed by rheumatoid arthritis, septic arthritis& tuberculous synovitis. Also cases of benign tumors including synovial lipoma arborescence, chondromatosis, pigmented villonodular synovitis and malignant tumors like synovial sarcoma and clear cell sarcoma were noted in present study. Conclusion: Histological analysis of synovial biopsies proves to be a valuable tool in establishing an early and specific diagnosis.

604-610

Authors: Padmaja Korti, Shailaja Prabhala, E. Jayashankar, Ashok Kumar Deshpande.

Introduction: Prostatic carcinoma has been increasing in India in the recent past. It is routine clinical practice to test for serum PSA followed by prostatic biopsy in all the suspected cases of prostatic carcinoma. Aims and Objectives: To study the histopathology of prostate biopsies and to correlate the serum PSA levels with TRUS guided biopsy findings of carcinoma and BPH. Materials and Method: This was a retrospective study carried out in the department of Pathology at Kamineni Academy of Medical Sciences and Research Centre, Hyderabad, over a period of three years. A total of 128 patients underwent TRUS guided prostate biopsy out of which only 61 cases were considered for the study as they had also undergone simultaneous prebiopsy serum PSA testing. The biopsy findings of carcinoma and BPH were correlated with serum PSA level. Observations and Results: The mean age for carcinoma and BPH was 66.5 and 64.6 years respectively. A total of 17 (27.8%) cases had serum PSA in the grey zone of 4-10 ng/ml. Among BPH cases, 33.3% showed an elevated serum PSA in the 20.1- 100 ng /ml range. A Gleason score of 3+4 was the most common score and was seen in 63.3% cases. The mean PSA for carcinoma was 48.7 ng/ml. High serum PSA in the range of 20.1- 100 ng /ml range was seen in 46.6% cases of carcinoma. Also 16.6% (5 out of 30) cases of carcinoma showed PSA in the grey zone. Conclusion: Serum PSA levels more than 20 ng /ml point towards carcinoma many cases of BPH can show values in the grey zone area that can cause unnecessary anxiety in patients. TRUS biopsies are useful for diagnosing prostatic adenocarcinoma.

618-621

Authors: Sandhya V, Malur PR.

Introduction: Testicular biopsy plays an important role in the evaluation of male infertility. In the present decade of Mapping of testis for foci of spermatogenesis and testicular sperm extraction for the treatment of infertility, testicular touch imprint cytology has again become a vital adjunct to open biopsy. Only two large studies have correlated touch imprint cytology with open biopsy. Aim: To correlate open testicular biopsy and Touch imprint in the evaluation of the cause of male infertility. Materials and Method: 30 infertile men with a sperm count of less than 5 million/ml after sperm wash and swim-up method were subjected to open testicular biopsy. A touch imprint was taken before the specimen was fixed in Bouin’s fluid. Hematoxylin and eosin staining was done. The biopsy and touch imprint were categorised into 5 groups based on Meinhard’s classification. Results: A 93.3% (28/30 cases) correlation was seen between open biopsy and touch imprint. Discordance was seen in 2 cases in which a definitive opinion was not possible in touch imprint cytology, while biopsy revealed tubular hyalinisation. Maturation arrest was the most common cause (76.67%) followed by Hypospermatogenesis, Sertoli cell syndrome and tubular hyalinisation, 6.7% each. A single case of obstructive azoospermia with normal spermatogenesis was seen. Conclusion: High correlation between testicular touch imprint and open biopsy makes it a useful adjunct in not only the evaluation of infertility but also in its treatment by assisted reproduction techniques.

629-631

Authors: Shreya AS.

Colorectal cancer (CRC) is the third most common cancer and the second most common cause of adult cancer related deaths worldwide.(1) Carcinoma of the colon and rectum is a relatively uncommon malignancy in India when compared with the western world. Colorectal cancer is generally a disease affecting individuals 50 years of age or older.(2,3,4) It has been estimated that between 2 and 3% of colorectal cancers occur in patients younger than the age of 40 years. Men have proportionately higher incidence of rectal cancer than women.(5,6,

638-642

Authors: R. Sujatha, Anushree CN, Neha Singh.

Introduction: Acute appendicitis accounts for one of the most common conditions that demands emergency surgery. It is a clinical entity with an ongoing diagnostic challenge. Grossly, normal-appearing appendix, removed from patients with suspected acute appendicitis, on histopathological examination may reveal a more serious underlying pathology. Hence, histopathological studies form the gold standard for diagnosis of acute appendicitis. Faecoliths are the usual cause of obstruction, though there are many other causes, ranging from inflammatory conditions to malignancies. Aim: To study histopathological patterns in all the patients who underwent appendectomy at our institution for a duration of 18 months, and to correlate with the clinical diagnosis. Materials and Method: This is a prospective study of 230 appendicectomies carried out at Dr. B.R. Ambedkar Medical College and Hospital during a period of 18 months from April 2015 to October 2016. Clinical data was collected from patients of corresponding appendicectomy specimens received in histopathology department of Dr. B.R. Ambedkar Medical College and were processed routinely. Sections obtained were studied to determine various histopathological patterns in appendicectomy specimens. Results: A total of 230 specimens were analyzed. 139(60.4%) were males and 91(39.6%) were females. The histopathological examination showed Acute appendicitis (46.5%), Chronic/recurrent appendicitis (27.8%), Acute suppurative appendicitis (6.5%), Eosinophilic appendicitis (3.5%), Gangrenous appendicitis (2.2%), Perforated appendicitis (1.3%), Carcinoid tumor (1.3%), Parasitic infestation (1.3%), Mucinous cystadenoma (0.4%). Negative appendiectomy rate was found to be 9.2%. Conclusion: Most of the cases in this study were diagnosed with usual features of appendicitis, though a few of them were essential incidental diagnoses which were missed preoperatively or intraoperatively. These important incidental diagnoses undeniably support the notion that all appendectomy specimens should be sent routinely for histopathological examination, which is not followed in many hospitals in India.

647-649

Authors: Mithila Bisht, Ranjan Agrawal, Parbodh Kumar, Amit Kumar Rana.

Solitary Fibrous Tumor (SFT) is a rare soft tissue tumor which has fibroblastic origin. SFT constitutes a heterogeneous group of rare spindle-cell neoplasms that include benign and malignant entities. It was originally described in the pleura. They may arise in non serosal areas like orbit, thyroid, nasal cavity and soft tissues. Herein, we present a case of 35 year old male who came with a painless swelling on the tip of the tongue. Histopathological examination of the excised tissue showed hypercellular and hypocellular areas with spindle shaped cells arranged in whorls and fascicles with interspersed collagen. Hemangiopericytomatous growth pattern was evident. Immunohistochemistry revealed positivity for Vimentin, CD34 and BCL-2, negativity for S-100, cytokeratin and desmin. IHC for Ki 67 revealed a low proliferative index. A diagnosis of solitary fibrous tumor was made. The case is being presented due to its rarity.

653-654

Authors: Ranjan Agrawal, Nitesh Mohan, Parbodh Kumar.

Schwannomas are benign neoplasms of the nerve sheaths. They are commonly known to occur in the head and neck region. Brachial plexus schwannomas are extremely rare. Diagnosis using fine needle aspiration plays a vital role in starting an early treatment. A case of giant sized schwannoma in the left axilla of a 35 year old lady diagnosed on FNAC is presented here with.

658-663

Authors: Aparna Dutta, Gayatri Gogoi, Projnan Saikia, Dimpee Lahkar.

Introduction: Rhabdomyosarcoma (RMS) is a rare tumor, with an annual incidence of 4.3 cases per million children. The orbit is the primary site in approximately 10% of these tumors. RMS is the most common malignant orbital tumor of childhood. It usually appears in the first decade of life. The mean age at diagnosis is 8 years. Boys are affected more than girls. Orbital RMS usually presents as a space occupying lesion in the orbit. The tumor has predilection for the superior nasal quadrant of the orbit. The common histological types include embryonal(60%), alveolar(20%) and pleomorphic (20%).The most common sites being sinuses, head and neck regions, genitourinary tract. CT and MR imaging are important in the evaluation of this tumor. The diagnosis is most rapidly and reliably confirmed by immunohistochemical(IHC) by demonstration of one or more muscle antigens. At times, the myxoid stroma and polypoid configuration of some RMS might be mistaken for nasal polyps or myxoma. Treatment usually consists of a combination of chemotherapy and radiation therapy following surgical excision. Case Report: In our study, a 1 year old male patient presented to a local ophthalmologist with complain of painless swelling of left orbit. CT scan revealed picture suggestive of venolymphatic malformation (March 17,2016) .Thereby, he was referred to a well known health care centre where MRI was advised which revealed a picture suggestive of rhabdomyosarcoma with differential diagnosis of plexiform neurofibroma. Total excision of the orbital mass was done at the same centre and a diagnosis of orbital myxoma/ angiomyxoma was given in HPE (April 29,2016). After about 2 months following the excision biopsy, patient’s parents noticed swelling of the same orbit which was aggresive. He was brought to the pediatric surgery department of AMCH and re-biopsied. One specimen was sent to our department and the other to a private centre. The report from the private laboratory suggested myxoma. The report from our college was given as Embryonal rhamdomyosarcoma and further subjected to immunohistochemistry (IHC). IHC was positive for desmin, myogenin and vimentin. Complete haemogram, ESR were within normal limits. Conclusion: In our case, the patient deteriorated within a very short span of 8-9 months due to misdiagnosis owing to its histological similarity to myxoma. The histopathologist reporting the case previously missed to observe the huge size of the tumour. The facility of IHC was also not utilized. Thus, histopathology along with IHC should be used as an ancillary test in cases as confusing as ours, thereby saving patients valuable time.

667-669

Authors: R. Banukeerthana, Leena D. Joseph, CN Sai Shalini, Ramya R, M. Nikitha.

Soft tissue metastasis of visceral cancers are uncommon, as these cancers usually metastasize to surfaces near the primary tumor. Metastasis of signet ring cell carcinoma of stomach to soft tissue is a rare entity and we report a case which presented to us with swelling in the chest wall, the biopsy of which proved to be a metastasis from an unknown primary in the stomach, which was also biopsied and confirmed.