Background:In recent times, high-resolution ultrasound thyroid imaging has paved the way for significant transformation in clinical approach to thyroid nodule. There are several risk stratification systems in thyroid imaging, developed with an aim, not only to reduce the inter-observer variability but also to establish effective communication system. Thyroid image reporting and data system (TIRADS) classification system, which is similar to breast imaging reporting and data system for breast lesion, is the most useful of all. To our knowledge, there is just a handful published research articles available based on Indian population in this regard. In this article, we study the thyroid nodules using high-resolution ultrasound in Indian population and we try to correlate the TIRADS and Bethesda system for reporting thyroid cytopathology.Materials and Methods:This prospective study includes 184 patients studied over a period of 2 years (April 2015–April 2017). Patients having thyroid nodule in B-mode ultrasound and are scheduled to get a fine-needle aspiration cytology (FNAC) done. Bethesda classification of these nodules is tabulated in follow-up period simultaneously. By comparing these data, efficacy of TIRADS in differentiating benign from malignant nodules are assessed finally using accuracy, positive predictive value (PPV), cross-tabulation, and Chi-square tests.Results:Out of the 117 TIRADS 2 nodules, none turned out to be Bethesda IV or higher, which means none of these nodules turned out to be malignant. The risk of malignancy for TIRADS 2, TIRADS 3, TIRADS 4, and TIRADS 5 was 0, 2.2, 38.5, and 77.8%, respectively. The risk of malignancy percentage in our study is similar to those values obtained in other prominent studies.Conclusion:The probability of a particular nodule being malignant can be effectively inferred from the ultrasound-based TIRADS system with a certain level of confidence. Considering our results and other literature reviews, it be can be safely assumed that FNAC can be at least deferred in patients having TIRADS 2 nodules, which contribute to majority of newly detected cases. In our experience, there is a remarkable correlation exists between TIRADS ultrasound classification and Bethesda cytology, especially for benign nodules.

A case of isolated splenic metastasis from carcinoma of the breast in a 54 year old woman, two years after treatment for breast carcinoma, is presented. There was no involvement of other organs like liver, bone, lungs, etc. The patient underwent splenectomy and recovered without any complications. This case is being reported because of the rarity of the lesion. Breast carcinoma with visceral metastasis to liver, bones, lungs, etc is common. Secondary metastasis in spleen, on the other hand, is a rare entity. Though it may occur along with other visceral metastasis, isolated involvement of spleen has not yet been reported. CASE REPORTA 54 year old woman presented with left hypochondrial pain and mild fever of one month's duration. She was known to have asthma and hypertension, and she had been operated on for carcinoma of the breast (tumour, node, and metastasis staging: T 2 N 1 M 0 ) by modified radical mastectomy two years earlier. The histopathological examination showed infiltrating duct carcinoma with three metastatic lymph nodes. Other possible sites of spread revealed no metastasis. There was no family history of breast cancer. The patient received chemotherapy (cyclophosphamide, methotrexate, and 5-fluorouracil; six cycles) and was on tamoxifen. Over the previous two years she had not had any significant illness.On physical examination, the patient was pale but moderately nourished. Abdominal examination revealed a mass 5 cm below the left costal margin, moving with respiration, directed towards right iliac fossa (splenomegaly). The liver was not palpable. There was no other palpable mass or ascites. Vaginal and rectal examinations were normal. The mastectomy bed, contralateral breast, and both axilla were normal. Haematological analysis showed anaemia and leucocytosis. Biochemical parameters including liver function tests and renal function tests were within normal limits. An ultrasonogram of the abdomen showed splenomegaly with a large cystic lesion in the spleen. Computed tomography of the abdomen and pelvis revealed an enlarged spleen containing a well circumscribed solitary hypodense area. The liver, retroperitoneum, and pelvis were normal. Computed tomography of the chest was normal. A splenic abscess or metastatic lesion to the spleen were considered. As there were no other lesions, the patient was prepared for laparotomy and splenectomy.Peroperatively the spleen was enlarged with an irregular surface and numerous adhesions. Few lymph nodes were present in the splenic hilum. The liver, bowels, and other viscera were normal; there was no ascites. Splenectomy was done and the postoperative period was uneventful. The patient was followed up for six months, with ultrasound scan of the abdomen, and there was no persistence or recurrent disease.The spleen was 12 × 11 × 8 cm, weighing 500 g, with an irregular surface. Cut section showed fleshy growth with extensive necrosis, 10 cm in diameter, with a rim of splenic tissue all around. Microscopic examination showed sheets and nests of cells having eosinoph...

Epithelioid hemangioendotheliomas are rare neoplasms involving any sites including soft tissue, lung, liver, kidney, etc. and many more. A multifocal hemangioendothelioma is extremely rare, and it can very well be mistaken as angiosarcoma with metastasis. Here, we describe a case of multifocal hemangioendothelioma which radiologically appeared like multiple metastatic lesions in paraspinal muscle, liver, kidney, adrenal, lung and gluteus muscle arising from renal cell carcinoma, lung carcinoma, or renal angiosarcoma. But histologically the picture is characteristic of epithelioid hemangioendothelioma. Morphological differentiation between an epithelioid hemangioendothelioma and epithelioid angiosarcoma is more helpful than the immunohistochemical markers.

Introduction: Columnar cell lesions (CCLs) of the breast comprise a spectrum of benign to atypical entities that have in common variably dilated terminal duct lobular units lined by columnar epithelial cells with prominent apical cytoplasmic snouts. They are increasingly being encountered in breast biopsies because their associated microcalcifications are detected on mammographic screening. Current study aimed to know the proportion and significance of columnar cell lesions seen along with carcinoma breast.Material and methods: Excision biopsy specimens of the breast which included both lumpectomies and mastectomies were studied in the department of pathology. Postchemotherapy specimens were excluded from the study.5 sections each were taken from adjacent breast tissues and studied for columnar cell lesions after staining with hematoxylin, and eosin.100 cases were included in this study.Results: Majority of the cases were diagnosed as IDC grade 2. One or the other columnar cell lesions were seen in the majority of invasive ductal carcinomas. CCLs may be characterized by a single layer of columnar cells (columnar cell change [CCC]), multiple layers with stratification and apical tufting (columnar cell hyperplasia [CCH]), or monomorphic cells with cytologic atypia (flat epithelial atypia [FEA]). The differentiation between CCC, CCH, and FEA is clinically significant: CCC and CCH are considered benign lesions, whereas FEA can be associated with, and even a precursor to, low-grade ductal carcinoma in situ and atypical ductal hyperplasia. Of the total 12 cases of grade 2 IDC, 8 cases (66.6%) showed columnar cell change, 4 of them showed columnar cell hyperplasia (33.3%) and 9 of them showed both flat epithelial atypia and ductal carcinoma in-situ changes (75%). Conclusion:A consistent correlation exists between columnar cell lesions and Carcinoma Breast which is evidenced by the presence of such lesions in diagnosed cases of carcinoma. Since columnar cell lesions represent a significant precursor for carcinoma breast, a multidisciplinary modality of approach will help to detect these lesions much earlier and will prove worthwhile