Smoking causes a large and growing number of premature deaths in India.

No abstract

Primary squamous cell carcinoma of the renal parenchyma is an extremely rare entity. The diagnosis of squamous cell carcinoma of the renal pelvis is usually unsuspected due to the rarity and inconclusive clinical and radiological features. Most of the patients are diagnosed at an advanced stage and are with poor outcome. Radical nephrectomy is the mainstay of the treatment. We reported a case of squamous cell carcinoma of the kidney in a 50-year-old female who presented with the right sided abdomen pain. The patient was treated with radical nephrectomy.

Bacground: Primary mediastinal malignant germ cell tumour (PMMGCT) is rare with unsatisfactory prognosis and pose difficulty in management due to lack of guidelines. Methods: All cases of PMMGCT diagnosed and treated between years 2014 to 2018 were retrospectively evaluated for clinico-pathological features, multimodality treatment and follow up. Results: Among a total of five PMMGCT cases, three were seminomatous and two were non seminomatous tumour [Yolk- sac tumour (n-1) and Mixed tumour (n-1)]. Four of these cases were non - metastatic with locally advancement and another one presented with metastasis to supraclavicular lymph node. All patients received platinum based induction chemotherapy. Post-induction chemotherapy, two cases of non seminomatous tumours underwent surgery. Among the three seminoma cases, one patient showed complete metabolic response; one with metastasis succumbed to the disease and the in-operable case of seminoma received local radiotherapy. Conclusion: PMMGCT needs a multi-disciplinary approach for appropriate diagnosis and management. Clinicopathological features like tumour site, extension, histopathological type, tumour stage and serum tumour marker are necessary for prognostication and decision making of further treatment plan.

A 79-year-old male patient initially presented with cystic swelling over left finger since 7 days. He had history of percutaneous coronary angioplasty (PTCA) done 7 years back and present echocardiography showed post PTCA status with ejection fraction 43% and hypokinesia of inferior and lateral wall. The patient had no past history of trauma to left hand, diabetes mellitus or tuberculosis. The present blood sugar level was within normal limit. At the initial presentation the possible differential diagnoses were infections, trauma, inflammatory arthritis, osteomyelitis, or gout. The present case due to clinical findings of erythema, swelling, pain and tenderness suspected as infectious cyst. The patient received oral antibiotic therapy with partial response. Cyst removal was done and histopathological examination revealed squamous cell carcinoma [Table/ Fig-1]. Subsequently, X-ray of left hand was done and showed lytic lesion in the distal phalanx of left index finger with soft tissue component [Table/ Fig-2]. Amputation of the finger was done and histopathological examination revealed as moderately differentiated squamous cell carcinoma infiltrating bone with tumour thickness of 6mm. Immunohistochemistry study was TTF-1 (thyroid transcription factor) positive and primary may be lung or thyroid. He developed radiating pain to pelvis and bilateral lower limbs. Physical examination showed only tenderness over lumbar spine area. Subsequently, Contrast enhanced CT scan showed a mass of size 3.2x3 cm in anterior segment of right upper lobe lung with mediastinal lymphadenopathy, multiple lung parenchymal metastatic lesions, right pleural effusion, multiple osteolytic lesions in dorsal (D7) and lumbar (L1, L2) vertebrae [Table/ Fig-3]. MRI scan of spine showed multiple spine metastases [Table /Fig-4]. Patient was provisionally diagnosed as metastatic squamous cell carcinoma of finger with possible primary from lung. Due to presence of TTF-1 marker on immunohistochemistry study, right lung mass on CT scan and multiple osteolytic spine lesions on MRI scan, the patient was finally diagnosed as carcinoma of lung with acrometastasis and spine metastasis. He received palliative radiotherapy of 30GY in 10 fractions to thoracic and lumbar spine by Co60 teletherapy machine. Due to co-morbid condition, patient and his attendant refused to give consent for further palliative chemotherapy. Patient was treated with supportive care and pain management. Bony metastases develop in 30% of all the cancers, but out of which only 1% to 3% occurs in the hand. Lung is the most common site for acrometastasis, followed by breast and renal cell cancer. Metastases to the digits are with non-specific presentation. We reported a case of 79-year-old male patient with initial presentation of swelling over left index finger, which was found to be squamous cell carcinoma of finger on histopathological examination. He was subsequently diagnosed as a case of squamous cell carcinoma of lung with acrometastasis. Keywords: Amputation, Bony metastases, Lung...