IntrOductIOnBilateral breast cancer (BBC) is not an uncommon entity in contemporary breast clinics. We have an increasing incidence of BBC as a result of improved life expectancy after breast cancer treatment and routine use of contra-lateral breast mammography in newly diagnosed breast cancers. Lobular cancer in the index breast, family history of breast cancer, young age at diagnosis of first cancer and BRCA mutations are important risk factors that are known to be at increased risk for BBC. [5]. Accordingly the incidence of SBC has been varying in different series. Controversies also exist about the origin of second cancer (metastatic spread or independent primary) and its prognostic significance. More often than not, women with BBC are treated with most radical surgeries based on the notion that these tumours are biologically aggressive. However, scientific evidence for this belief is divided. There is no population based or large sample size studies analysing the survival outcomes of BBC in Indian women. The objective of this study was to define the epidemiological and tumour characteristics of bilateral breast cancer in India. Here in this study we analysed the clinical and pathologic characteristics, treatment parameters and outcome of BBC in Indian women from a single institution cohort. mAterIAls And metHOdsWe examined a consecutive cohort of breast cancer patients treated at our center between January 2007 to March 2015. A total of 1251 breast cancer patients were treated during this period. Clinical details were prospectively collected which include patient characteristics, tumour pathology, treatment variables, disease free survival and date of death. Patients were followed up with routine clinical examination, annual mammogram and other investigations if required.In this period 30 patients were found to have BBC which constituted the study population. This study was approved by institutional ethical committee and informed consent was obtained from all the patients who were included in the study. Synchronous bilateral breast cancers (SBC) was defined as two tumours diagnosed within an interval of 6 months and a second cancer diagnosed after 6 months was labelled as metachronous breast cancer (MBC). A patient was considered to have positive family history when a first degree relative had a history of breast cancer. Analyses of various patient and tumour characteristics were done in this prospective data base of BBC patients. resultsOverall 30 patients had BBC during the study period and majority were synchronous tumours (93.3%; n=28). Most patients with synchronous tumours (n=25) had their second cancers diagnosed during the initial presentation. Three SBC patients had their contralateral cancers diagnosed during 3, 4 and 6 months after the first tumour. Two cases of MBC were diagnosed 16 and 54 months after the first tumour [Table/ Fig-1]. Infiltrating ductal carcinoma was the commonest histological type (n =51) followed by DCIS, lobular and papillary types (n=7, 1, 1 respectively). DCIS was present...

A 75-year-old male presented with history of abdominal pain and generalised weakness for about three months. Clinically he was anaemic and per abdomen examination was unremarkable. Oesophagogastroduodenoscopy revealed an ulceroproliferative polypoidal growth involving the gastric antrum [Table/ Fig-1] and few scattered small sessile nodules in the body and antrum of stomach. Colonoscopy revealed a polyp in the rectum. The gastric antral lesion was biopsied and rectal polyp was excised and sent for histopathological examination. The patient also had an enlarged left supraclavicular lymph node which was also biopsied. Gastric antral lesion was reported as a moderately differentiated adenocarcinoma with papillary pattern and the rectal polyp was reported as ganglioneuroma [Table/ Fig-2]. The supraclavicular lymphnode showed a necrotising granulomatous inflammation, however the special stains such as Zeihl-Neelsen and Periodic Acid Schiff (PAS) for tuberculosis and fungi were negative.A radical subtotal gastrectomy with D2 lymphadenectomy and Billroth I anastomosis with feeding jejunostomy was done. Specimen was fixed in 10% neutral buffered formalin and representative sections were taken. Grossly, there was a raised ulcerated lesion involving the gastric antrum along the greater curvature measuring 5.0 x 3.0 AbSTRACTAlpha Fetoprotein (AFP) producing gastric carcinomas are very rare and have unique clinicopathological features and an extremely poor prognosis. Here, we report a case of AFP producing gastric carcinoma with three distinct histomorphologic patterns such as yolk sac like, hepatoid, tubular and papillary adenocarcinoma components. The uniqueness of this case is absence of metastases and associated findings such as fundic gland polyposis with varying degrees of dysplasia, gastric and duodenal well differentiated neuroendocrine tumour and rectal ganglioneuroma. The patient is symptom free as of two and half year's postoperative period.

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