We report a case of lung carcinoma metastasizing into a meningioma in a 68-year-old female, who presented with progressively worsening right-sided hemiparesis and multiple episodes of adult onset epilepsy. Magnetic resonance imaging revealed an oval-shaped extra-axial hypointense lesion with a central hyperintense nodule in the left frontal region favoring a most probable diagnosis of a meningioma. Left frontoparietal craniotomy and excision of the tumor were carried out and histopathology with hematoxylin and eosin stain revealed a meningioma with metastatic adenocarcinoma and was confirmed by immunohistochemistry. The origin of metastasis was presumed to be from the lungs. A computed tomography (CT) scan of the chest with contrast showed a 3.1 x 2.9 cm mass with spiculated margins in the left lower lobe. Fine needle aspiration cytology (FNAC) proved it to be adenocarcinoma.

Background: Total knee arthroplasty is associated with hematoma formation and extensive blood loss up to 1.5 liters. The placement of a closed suction drain to control this complication is controversial. The purpose of this study is to determine the efficacy between total knee arthroplasty without a drain and with a closed suction drain. Methods: A retrospective cohort study was conducted between January 2014 and December 2015 on 100 patients to assess the hemoglobin and hematocrit levels, the rate of allogeneic blood transfusion, and the length of hospital stay in patients with a closed suction drain versus no suction post-total knee arthroplasty.Results: Fifty-six units of packed red blood cells were transfused in 36 out of 50 patients (72%) in the closed suction group compared to 21 units of packed red blood cells in 18 out of 50 patients (36%) in the no suction group after 24 hours post-surgery. The hemoglobin levels at multiple intervals were lower in the closed suction group (p < 0.05). The closed suction group also had an extra one-day stay in the hospital (p = 0.0492, 95% CI = 0.70 - 0.94).Conclusion: Closed suction drain placement is associated with low hemoglobin levels, an increased rate of allogeneic blood transfusion, and a longer hospital stay.

Chronic expanding hematoma is a rare pathology, which has not been previously described as a complication of gunshot injury with retained bullet fragments. Because of the similar characteristics of chronic expanding hematoma to malignancy, it can present a diagnostic challenge for clinicians. Imaging and biopsy evaluation is needed to reach a conclusive diagnosis and implement appropriate treatment. In this case report, we will discuss the development, diagnosis, and management of a chronic superficial cervicothoracic mass in a patient who presented 30 years post-gunshot injury with retained bullet fragments.

ObjectiveTo determine the application, success and complications of the utilization of free vascularized fibular grafts (FVFG) in the reconstruction of lower limb defects after resection of primary lower limb musculoskeletal tumors.MethodologyThis descriptive retrospective case series analysis was conducted at Shifa International Hospital from January 2011 to January 2016. It included patients who had premalignant and malignant conditions of the lower limb and subsequently had the lesion resected followed by FVFG surgery. The data collected was to outline the demographic profile, clinical features, and post-procedure outcomes and complications.ResultsThere was a total of six patients. The mean age of the patients was 25.8 ± 11.8 years (range: 15-40 years). The patients presented with pain, swelling, inability to bear weight and/or restriction of movement at the joint. Postoperatively, one patient had proximal wound necrosis and one patient had a thrombus in the anastomosed vessels, both of which were managed successfully.ConclusionWith a success rate of 100% at the end of the six-month follow-up period, FVFG surgery is a reliable procedure that may be successfully carried out for musculoskeletal tumors of the lower limb with minimal complications.

Background: Malignant mammary gland tumors can metastasize to various organs; of which, lungs and regional lymph nodes are most frequently affected. Chest radiographs and regional lymph node FNAs are important diagnostic tool to detect metastasis as per oncology practice guidelines. The present study was aimed to develop suitable diagnostic tool to detect metastasis in mammary tumor affected dogs. Methods: Between September 2017 to July 2018, thirty three dogs (n=33) affected with mammary tumors were included in the study. Out of thirty three dogs, three dogs (n=3) showed swollen regional lymph nodes and pulmonary metastases. Different parameters such as haematology, serum biochemistry, radioimmunoassay, radiology, cytology, histopathology and immunohistochemistry were analysed. Result: TNM clinical staging revealed that all the three dogs showed stage IV tumors which were usually malignant and showed frequent metastases. Haematological abnormalities such as anemia, leucocytosis and reduced platelet count were noticed. Serum biochemistry showed reduced protein and electrolyte level with elevated alkaline phosphatase and alanine transaminase. Radioimmunoassay showed many-fold elevation of estradiol and progesterone. Radiography of lungs revealed severe pulmonary metastasis. Cytological examination of swollen accessory lymph node revealed mixed population of lymphocytes and neoplastic cells. Grossly, the lymph nodes were found to be enlarged, blood tinged and covered with subcutaneous adipose tissue. Histopathology of tumor masses from three dogs revealed cystic papillary carcinoma, ductal carcinoma and anaplastic carcinoma. Immunohistochemistry revealed that dogs were affected with triple negative tumors which were highly malignant, poor prognosis and not responding to therapy.