Cystic lymphangiomas are benign lymphatic tumours which usually affect the paediatric population and are predominantly located in the head and neck region. Its occurrence during adulthood and an intra-abdominal location are both extremely uncommon. Clinically and radiologically, these lesions often mimic malignancy. Infrequently, these tumours can undergo degenerative and reactive changes obscuring the diagnostic features. We describe hereby an anecdote of cystic lymphangioma with marked reactive changes presenting with the features of gastric outlet obstruction in an adult patient.

Phyllodes tumors are uncommon fibroepithelial neoplasms of breast. Heterologous sarcomatous differentiation of malignant phyllodes tumor (MPT) is a rare phenomenon as shown in the literature. Herein we report a series of nine cases from a tertiary care centre in Eastern India. Patients demographic data and clinical details were obtained from the medical records. Histopathology and immunohistochemical studies were analysed and diagnosed accordingly. Out of 38 cases of PT, 13 were found to be MPT, of which 9 cases showed heterologous differentiation in the form of angiosarcoma, fibrosarcoma, undifferentiated sarcoma, extensive squamous differentiation and with lipomatous metaplasia. Proper diagnosis and subtyping of the sarcomatous component is essential for deciding the correct treatment modality and prognostication of the disease. However there is no clear cut treatment protocol is available because of paucity of data.

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A 60-year-old male farmer had bilateral filarial lymphoedema of both legs for last 30 years. He presented with the complaint of foul smelling multiple ulcero proliferative lesions encircling the right ankle region from three months duration. To start with there was a small nodular growth in the same site for one and half years back, which was gradually increasing in size and ulcerated with serosanguinous discharge. It was managed conservatively in another hospital with dressing and oral antibiotics. The lesion progressed to a large fungating and multinodular mass which was foul smelling. Some of the nodules showed surface ulceration with oozing.On physical examination both limbs were markedly oedematous but oedema was more in the right lower limb, skin of both legs were markedly thickened with a circumferential nodular mass measuring around 25 cm located above the right ankle region [Table/ Fig-1a-c].Inguinal lymphnodes of both sides were not palpable. Laboratory investigations revealed peripheral eosinophilia with absolute eosinophilic count of 1.89x103 cells per microliter, increased Erythrocyte Sedimentation Rate (ESR) (86 mm in first hour) and normal fasting blood sugar (86 mg/dl). The serological tests for HBsAg, HCV and HIV were negative. Liver function test was normal. No microfilariae was found on peripheral smear. Fluorescent antibody test for Wuchereria bancrofti and Brugia malayi antigens were negative. Culture report from the wound discharge grew Edwardsiella and Enterococcus, which were sensitive to Cefixime, Ceftazidime, Levofloxacin, Ciprofloxacin and Tazobactam-Piperacillin. Chest X-ray was normal. X-ray of right lower limb showed no involvement of underlying bone. Computed Tomography (CT) scan of whole body and abdomen showed no distant metastasis [Table/ Fig-2a-d]. He had a family history of filariasis of his mother and belonged to an endemic region of filariasis. The patient had undergone surgery for hydrocele which was of filarial origin 10 years back for which no details were available. Incisional biopsy from the circumferential growth was obtained.Histopathological study revealed islands, clusters and small nests of tumour cells with round to oval plump nuclei and conspicuous nucleoli arising from the basal layer of epidermis and infiltrating the dermal papillae, papillary dermis and reticular dermis with variegated morphology [Table/ Fig-3a]. In few areas the tumour cells were spindle shaped resembling a sarcoma [Table/ Fig-3b]. Prominent interspersed vascular channels lined by atypical cells of both spindle and epithelioid cells and foci with clear cell change were seen [Table /Fig-3c,d]. The arrangement of tumour cells varies from papillary to organoid, nesting and alveolar patterns [ Based on histopathology and immunohistochemical markers, a diagnosis of amelanotic melanoma with a proliferative index (MIB1) of 4 % was made. Clark's level was IV and TNM stage was IIC. After consideration of all the available treatment modalities, wide local excision of the tumour was done followed by ski...

Background: Surgery is the only potentially curative modality for early-stage non-small cell lung cancer (NSCLC) patients. However, 30% to 55% of patients develop recurrence. In this work, we explored the role of radiomic (computer extracted image) features from within and outside the lung nodule on baseline CT scans to predict risk of recurrence in early-stage NSCLC patients. Method: 110 patients with earlystage NSCLC were identified for the study. All patients underwent surgery with the primary tumor having recurred (relapsed) in 34 cases within 5 years of surgery. Tumor ROIs were contoured by an expert reader using the 3DSlicer program on chest CT scans. Radiomic texture features were extracted from within and outside the primary lung nodule on the same scans. Four rings of annular peri-tumoral regions were analyzed, each with a 5 mm increment leading upto maximum radius of 20 mm from the nodule center. Patients were randomly divided into training (N¼60) and testing (N¼50) cohorts and 5 most predictive radiomic features from out of a total pool of 2892 were selected from the training set via a feature selection algorithm and used to train a Random Forest (RF) classifier to predict risk of recurrence. The RF classifier was then evaluated on the test set via the area under the receiver operating characteristic curve (AUC). Result: The most predictive features were the Haralick entropy features within the 0-5mm and 5-10 mm annular rings outside the tumor (p-value <0.01). The RF classifier in conjunction with the 5 most predictive features yielded an AUC¼0.77 in predicting recurrence vs non-recurrence in early stage NSCLC. Conclusion: Our results suggest that computer extracted texture features of the peri-tumoral region is predictive of disease recurrence in early-stage NSCLC. Additional independent, multi-site validation of these findings is warranted.