Background:Fine needle aspiration (FNA) with assistance of radiological tools such as ultrasonography (USG) and computed tomography (CT) is an effective and safe technique for diagnosing intra-abdominal neoplastic and nonneoplastic lesions.Aims and Objectives:(1) To assess the utility of image-guided cytology in the diagnosis of intra-abdominal lesions. (2) To categorize various intra-abdominal lesions according to their site of occurrence and study their cytomorphological features.Materials and Methods:A cross-sectional study was conducted in the Department of Pathology between January 2012 and January 2015. A total of 174 cases with intra-abdominal lesions were included in the study.Results:In our study, diagnostic yield was 84.5%. The mean age was found to be 52 years with M: F ratio 1.1:1. We found that 92 (52.87%) cases were in hepatobiliary region, 33 (18.96%) in adnexa, 13 (7.47%) in pancreatic-ampullary region, 14 (8.04%) in unknown abdominal lumps, 8 (4.6%) in lymph nodes, 6 (3.4%) in renal, 5 (2.87%) in retroperitoneum, 2 (1.1%) in omental nodules, and 1 (0.5%) in splenic mass. Of total 174 cases, 106 (61%) cases were malignant, 10 (5.7%) benign, 16 (9.1%) inflammatory, 27 (15.5%) inadequate, and 15 (8.7%) suspicious for malignancy.Conclusion:Ultrasound and CT-guided FNA cytology had a significant role in diagnosis of palpable and nonpalpable intra-abdominal lesions. Being a relatively quick and safe method, it also avoids invasive diagnostic procedures.

Accessory and cavitated uterine mass is rare developmental Mullerian anomaly. There is a non-communicating uterus-like mass that occurs contiguously along wall of uterus often underdiagnosed and needs expertise to identify. To raise awareness, provide information about this pathology and emphasize role of coronal 3D ultrasound in its diagnosis. A 28-year-old married female presented with dysmenorrhea and chronic pelvic pain. On ultrasound, a homogeneously isoechoic mass was noted in right lateral wall of uterus with central echogenicity. On 3D reconstruction, the main uterine cavity was normal and both cornu were visualized without any recognized Mullerian anomaly. No communication with the main endometrial cavity seen. On laparoscopy, mass was located under right round ligament insertion. Sectioning revealed chocolate colored fluid. ACUM is non-communicating uterus-like mass. It resembles uterus both macroscopically and microscopically. It represents a cavitated mass lined by endometrial glands and stroma surrounded by irregular smooth muscle cells. Criterias for diagnosing ACUM are (1) accessory cavitated mass located under round ligament; (2) normal uterus, fallopian tubes, and ovaries (3) surgical case with excised mass and pathological examination; (4) accessory cavity lined by endometrium with glands and stroma; (5) chocolate-brown fluid contents. On ultrasound, they appear solid isoechoic masses with central cystic areas separate from ovaries. 3D reconstruction can be used to rule out Mullerian anomaly. ACUM is a rare surgically treatable cause of dysmenorrhea, often underdiagnosed due to lack of knowledge about entity. 3D ultrasound can be highly accurate in making the diagnosis.

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Primary breast carcinoma is a common pathology in the UK. It can present with metastatic deposits but it is rare that lesions in the breast are the sole primary or secondary presentation for metastatic cancer from other sources. We present a case of a primary peritoneal cancer recurring after optimal treatment with a new breast lesion and the diagnostic difficulties that this can cause.Primary breast cancer is a common condition: 1.38 million patients were diagnosed worldwide in 2008.1 Metastatic disease to the breast from extramammary sources (excluding metastasis from contralateral breast cancer) is rare. While uncommon, a number of sites have been previously implicated as the primary tumour site metastasising to the breast, including ovarian and gastric cancers, cutaneous malignancies and lung cancers.2,3 It has also been noted that secondary breast cancer can present with microcalcification and can therefore appear as incidental lesions detected on screening mammography. 2History taking can elicit this potential diagnostic pitfall in ascertaining whether patients have suffered with other cancers. However, it should be noted that the metastasis can be present before the primary tumour has been identified and therefore close clinicopathological correlation is needed at multidisciplinary discussions. 4 Case historyA 78-year-old woman who was treated for a primary peritoneal carcinoma presented to our fast track breast clinic a year later with a lump. She had initially presented to a regional gynae-oncology centre with abdominal pain, weight gain and ascites. She underwent a diagnostic laparoscopy with biopsy that demonstrated a poorly differentiated high grade serous carcinoma, most likely of primary peritoneal origin.She received four cycles of neoadjuvant chemotherapy with carboplatin and paclitaxel followed by optimal cytoreductive surgery (laparotomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy with optimal debulking) and two cycles of post-operative chemo-