Langerhans cell histiocytosis (LCH) is a rare disease of antigen presenting cells and involvement of thyroid is really uncommon. The thyroid if involved is usually seen in multisystem disease but isolated thyroid involvement is very rare. The diagnosis of Langerhans cell histiocytosis of the thyroid is very challenging due to its rarity and is usually misdiagnosed as benign goiters, undifferentiated carcinoma, lymphoma, etc. Management of Langerhans cell histiocytosis of the thyroid also remains controversial. Prognosis in an isolated Langerhans cell histiocytosis of the thyroid is usually good but as it may precede a multisystem involvement, prolonged follow-up is required. We present a rare case of Langerhans cell histiocytosis of the thyroid, with variable diagnoses on fine needle aspiration cytology.Keywords Thyromegaly . Langerhans cell histiocytosis . Thyroid tumor . Lymphoma thyroid Case StudyA 45-year-old male presented with thyroid swelling for 1 year duration, which was indolent in its course. He had no other complaints. He had no symptoms of hypo or hyperthyroidism. His other medical problems were diabetes mellitus and hypertension. On general examination, the patient was obese, PR-78/min, Bp-160/100 mmHg. Examination of the neck revealed diffusely enlarged, firm thyroid of size 15×8 cm with no nodules. Cervical lymphnodes were not palpable.On investigating, complete hemogram and renal parameters were normal except for elevated blood sugar values for which the patient was started on insulin therapy. Thyroid profile showed normal levels of T3 and T4 with mild elevation of TSH. Antithyroid antibodies were negative. USG of the neck showed goiter with altered echoes. FNAC reports were indecisive, varying between colloid goiter and anaplastic carcinoma. CT of the neck showed diffusely enlarged thyroid with heterogenous attenuation, likely malignant. USG of the abdomen was normal. Both vocal cords were mobile on video-laryngoscopy.The case was discussed in the tumor board and planned for total thyroidectomy for definitive diagnosis. Intraoperatively, the thyroid gland was found to be diffusely enlarged and densely adherent to the strap muscles and trachea. Total thyroidectomy was completed with difficulty after preserving recurrent laryngeal nerves on both sides. The specimen was sent for histopathology (Fig. 1). During immediate postoperative period, patient developed stridor, probably due to tracheomalacia, so he was reintubated. The patient was gradually weaned from ventilatory support and extubated on the 6th postoperative day.Initially, the histopathology of the specimen was reported as non-Hodgkin's lymphoma. With this diagnosis, he was further evaluated for involvement of other sites. CT of the chest, CT of the abdomen, and bone marrow aspiration were

Background: Breast cancer is common cancer among females in rural India and is rapidly catching up to cervical cancer in rural India. Metastasis can occur after the initiation of treatment or at the time of diagnosis. The stage at initial presentation and underlying biology of the tumor has an impact on prognosis and metastasis of the tumor. The objective of the study was to study the correlation between tumor size and lung metastasis and to find the correlation between ER, PR status, and lung metastasis.Methods: This study was conducted in 82 patients with breast carcinoma coming to the department of the general surgery and oncology at Government Stanley Medical College and Hospital. Details of cases and full history obtained. Routine blood investigations were done. Tumor size is evaluated by clinical examination and imaging. For all patients, core needle biopsy is done to confirm the diagnosis and receptor status. IHC status of the tumor is obtained from the pathologist. Presence of lung metastasis documented by CECT chest.Results: In this study, the prevalence rate of lung metastasis in carcinoma breast patients is 9.75% Total number of Carcinoma Breast are 82, in which lung metastasis is seen in 8 cases and CECT chest is normal in 74 patients. The prevalence rate of lung metastasis in ER-positive patients is 9.90%. The prevalence rate of lung metastasis in ER-negative patients is 10.81%. The prevalence rate of metastasis in PR positive patients is 9.52%. The prevalence rate of metastasis in PR negative patients is 10%. Of 34 cases with HER-2 positive status 3 patients presented with lung metastasis with a prevalence rate of 8.82%. Of 48 cases with HER-2 negative status 5 cases presented with lung metastasis with a prevalence rate of 10.42%.Conclusions: In this study prevalence of lung metastasis in carcinoma breast is 9.75%. There seems to be no correlation between ER, PR and HER-2 neu status and lung metastasis. There is also no correlation between clinically T2 and T3 tumors and lung metastasis. Whereas clinically T4 tumors seem to have a higher incidence of lung metastasis.

Background: Intestinal obstruction is a major part of the emergency caseload in a general surgical department. It can pose diagnostic and treatment challenges with its varied presentation and multiple management options. The surgeon needs to use astute judgment to spot the diagnosis and plan the line of management. The aim of the study is to show the various etiologies most commonly presenting with intestinal obstruction in our institute in north Chennai. It also aims to evaluate markers of postoperative morbidity.Methods: This is a prospective study of about 50 patients with acute intestinal obstruction coming to the emergency department of the Government Stanley Medical College and Hospital from the time the patients were admitted they were followed up till their time of discharge/ death. X-ray abdomen erect and supine and CECT abdomen and pelvis were routinely taken for all the patients.Results: X-ray abdomen supine showed multiple air fluid levels as the commonest finding which was seen in 42 cases, 27 cases had dilated bowel loops and 2 cases showed coffee bean appearance. 6 cases had fluid levels less than 3 and were deemed in 49 cases and was inconclusive in 1 case to be inconclusive. CECT showed features of obstruction or pathological obstruction point.Conclusions: Corrections of dehydration and rapid resuscitation with correction of electrolyte disturbances would go a long way in reducing morbidity and mortality. Surgical intervention in a timely manner is the treatment of choice and prognosis is good when it is not delayed.

Antiphospholipid antibody syndrome (APS) is an autoantibody mediated thrombophilia characterised by recurrent arterial or venous thrombosis and/or pregnancy morbidity. APS presenting as thrombosis in mesenteric venous system is relatively uncommon (10%). Here, we present a case of primary APS presenting as acute superior mesenteric vein (SMV) thrombosis in a 38-year-old female. She was admitted with the complaints of abdominal pain and constipation for five days. Her abdomen was distended with sluggish bowel sounds. Her abdominal contrast enhanced computed tomography revealed thrombosis of SMV, splenic vein and portal vein. She was initially kept on conservative management and started on anticoagulants. Her coagulation work-up revealed that she was positive for anticardiolipin antibody and therefore, the diagnosis of APS was made. She was continued on conservative management and anticoagulants. On the tenth day of admission, after starting oral diet, she developed severe abdominal pain and abdominal signs of peritonitis. She was then taken up for emergency laparotomy. Intraoperatively; there was 100 cm of gangrenous ileal segment, about 60 cm from ileocecal junction and 160 cm from duodenojejunal flexure. The gangrenous ileal segment was resected and a double barrel ileostomy was constructed. She had an uneventful postoperative recovery and was started on lifelong anticoagulants.