Rhino-orbital-cerebral zygomycosis is a potentially lethal, opportunistic, fungal infection with protean manifestations, rapid progression, unpredictable course and high mortality. It is associated with angioinvasion and infarction, usually observed in diabetic ketoacidosis, immuno-compromised states and rarely reported in an apparently normal host. We present a case of an18-year-old patient with a chronic, painful, non healing ulcer with necrotic margins over the right side of the face which extended to both orbits involving eyes within a period of 1.5 month. Later he developed severe headache, decreased vision, inability to speak, seizures and status epilepticus with fatal outcome. Awareness of its occurrence in normal patients with prompt diagnosis and appropriate management may improve the outcome and decrease mortality.

BACKGROUNDPleomorphic Adenomas are the most common benign neoplasms of the salivary glands and are a diverse group of lesions. Most common site being major salivary glands, of which parotid gland constitutes 64% -80%. Fine Needle Aspiration Cytology (FNAC) of palpable salivary lesions is accepted as a useful preoperative diagnostic tool worldwide. Cytomorphological and histological diversity encountered in pleomorphic adenomas causes enormous diagnostic difficulty. Objective-The present study was done to evaluate the cytomorphological features of pleomorphic adenomas with an emphasis on differential diagnoses, challenges encountered during the diagnosis and addressing potential pitfalls. MATERIALS AND METHODSThis descriptive study was undertaken at the Upgraded Department of Pathology, Osmania General Hospital over a period of one (1) year and nine (9) months, that is from January 2016 to September 2017. Our study included 64 cases of pleomorphic adenoma diagnosed on fine needle aspiration cytology. Rapid Haematoxylin and eosin and Papanicolaou stains were used. Cytological smears were reviewed for nature of aspirate, patterns of epithelial component, type of mesenchymal matrix and degenerative changes like metaplastic and cystic changes. Radiological and histopathological correlation was available in all the cases. RESULTSA total number of 116 salivary gland lesions were aspirated, of which Pleomorphic adenomas were 64 (55.1%), chronic sialadenitis were 18 (15.5%), retention cysts were 12 (10.3%), sialadenosis were 8 (08-6.8%) and 3 cases of (03-2.5%) benign neoplasms-out of which two cases were Warthin's tumour and one case of monomorphic adenoma. Malignant lesions were 11 cases (9.4%). CONCLUSIONFNAC, though an accurate procedure for diagnosing pleomorphic adenoma, mostly poses diagnostic challenges because of the remarkable degree of cytomorphological diversity, for which pleomorphic adenoma earns a special distinction. Awareness of these variations is needed by the cytopathologist to avoid diagnostic errors.

BACKGROUND We wanted to evaluate the role of platelet indices in differentiating reactive and clonal thrombocytosis. METHODS This is a cross sectional observational study conducted for two years among 150 patients with platelet counts of 5 lac and above. Thrombocytosis and utility of platelet indices like Mean Platelet Volume (MPV), Platelet Distribution Width (PDW) for the differential diagnosis of thrombocytosis were done. RESULTS Out of total 150 cases, 144 (96 %) had reactive thrombocytosis, and 6 (4 %) had clonal thrombocytosis. Infectious aetiology is seen in 64 (42.6 %), tissue injury 35 (23 %), rebound thrombocytosis 22 (14.6 %), anaemia 13 (8.6 %), multiple causes 8 (5.3 %), clonal aetiology 6 (4 %), and inflammatory 2 (1.3 %). Patients with reactive thrombocytosis showed a lower mean platelet volume and platelet distribution width compared to primary thrombocytosis. In reactive thrombocytosis MPV range, 6.0 - 8.0 fl with mean MPV 6.5 fl and PDW ranges from 14.0 - 16.2 % with mean PDW 15.3 %. In clonal thrombocytosis MPV range, 6.9 - 8.5 fl with mean MPV 7.9 fl and PDW range was 15.9 - 17.2 % with mean PDW 16.4 %. CONCLUSIONS On analysing the platelet counts and indices, patients with high counts, low MPV and PDW suggested reactive aetiology and patients with high counts and high MPV and PDW suggested clonal aetiology. KEYWORDS Thrombocytosis, Mean Platelet Volume, Platelet Distribution Width

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BACKGROUND Neuroendocrine tumours occur at various sites in the human body. They are considered as one of the close differentials for many tumours. Various benign and malignant tumours undergo neuroendocrine differentiation. Its incidence is slightly increasing due to advanced imaging modalities. Although rare, they can be seen in breast, gallbladder and skin. The aim of the study is to study the spectrum of neuroendocrine tumours from various sites, their clinical presentation, histomorphological features with immunohistochemistry and review of literature. MATERIALS AND METHODS This is a retrospective study for a period of 3 years (June 2013-June 2016). Surgical resection specimens were included in the study. Out of the total specimens received, 24 cases were of neuroendocrine tumours. Differential diagnosis of small round cell tumours also was considered and a panel of immunohistochemical markers were included to rule out them. Biopsy specimens were excluded from the study. RESULTS Out of the 24 cases, 18 cases were benign lesions. 6 cases were malignant lesions. Female preponderance was noted. Peak incidence was seen in 20-30 years of age group. CONCLUSION Neuroendocrine tumours can occur anywhere in the body and it should be considered in one of the differential diagnosis. Diagnosis must be accurately made.