ABSTRACTwe describe an unusual case of a Peutz-Jeghers syndrome associated with a composite synchronous cervical neoplasia comprising precursor "lobular endocervical glandular hyperplasia (LEGH)", "minimal deviation adenocarcinoma (MDa)" and "gastric-type adenocarcinoma (GTa)" along with a serous tubal intraepithelial lesion (STIL) in the right fallopian tube. a 24-year-old woman presented with a white mucoid discharge and bleeding per vaginum for one year. Histopathological evaluation showed MDa & GTa in FIGo grade III with pelvic lymph node metastasis despite a deceptively bland tumour morphology and low ki-67 index, indicating an aggressive tumour course and poor prognosis. Diagnostic marker profile in the cervix showed gastric type mucin and positive expression of ck-7, ck-20 (patchy), cEa, and negative cDX-2, p16, ER and PR. Further an attempt at eliciting the oncogenesis pathway in view of the p16 and HPV negative nature of the gastric type cervical adenocarcinoma showed negativity for p53 but activation of cyclin D1. Growth factors including Her2 and EGFR were negative while VEGFR was over-expressed. She was treated by radical hysterectomy and pelvic radiation. She was free from recurrence at the 12-month follow-up. This is a first-time report of a STIL in the fallopian tube which was validated by a unilateral mutant type p53 expression and increased ki67 index, associated with synchronous gastric type adenocarcinoma of the cervix in all stages of evolution.

Background: Elevated intracranial pressure is a complication of several traumatic as well as non-traumatic medical conditions. Clinical diagnosis can be difficult as it may present with non-specific complaints such as headache, vomiting, blurred vision, vomiting and altered sensorium. The expertise to perform ophthalmoscopy is not always immediately available in emergency rooms and the access to cross sectional imaging may be limited. Distention of the optic nerve sheath is an early sign of raised ICP as it is in direct communication with the subarachnoid space. Ultrasound is a widely available tool in emergency situations which can be used to measure the optic nerve sheath diameter (ONSD).Methods: In this prospective observational study, 36 patients suspected of having elevated intracranial pressure underwent high resolution B-scan ultrasound to measure the ONSD. Further, patients underwent CT scan of head and were evaluated for signs of raised ICT. Sensitivity and specificity of B-scan measurement of ONSD with CT scan was compared.Results: The ONSD measurement was 88.5% sensitive (95% CI 68% to 97%) and 90% specific (95% CI 55% to 99%) with CT as the reference.Conclusions: Bedside ultrasound B-scan measurement of the optic nerve sheath diameter provides information about raised intracranial pressure with a high sensitivity and specificity.

Synovial hemangiomas are uncommon benign tumours of vascular origin arising in relation to the synovium of joints or bursae. Usually, a long-standing history of pain and joint swelling is present affecting children and adolescents especially in the knee or elbow joint. We present two cases of knee swelling diagnosed as synovial hemangioma.