All findings were analysed using SPSS 19.0 software. Results: Ampullary (periampullary) carcinomas were much more common than carcinomas of the head of the pancreas, especially in males, with an average age of 53 years. Mean tumor size was 2.5 cms, over 54% were well differentiated. A large majority were pT2 or pT3 and N0. Carcinomas of pancreatic head were also more common in males, mean age was 55 years, mean tumor size was 3.5cms, and over 65% were moderately differentiated. The majority were T2 or T3 and pN1. Prognostically, significant statistical correlation was seen with tumor grade and pathologic T and N stage (p values statistically significant). However, tumor size was not statistically significant. Conclusions: Ampullary carcinomas are more common compared to pancreatic carcinomas. Majority of ampullary carcinomas were well differentiated while majority of pancreatic carcinomas were moderately differentiated. Large majority of both types of cases were pT2 or T3. Histologic tumor grade and pathologic T and N stage are significantly related to prognosis in Pakistani patients with ampullary and pancreatic cancers.Keywords: Whipple resection -carcinoma of ampullary region -carcinoma of head of pancreas -tumor grade

Chondrosarcoma is a cancer of cartilage cells, and despite being a common primary bone tumor, tracheal chondrosarcoma is rare with only 18 cases reported in the literature prior to mid-2016. A 60-year-old gentleman presented with progressively increasing cough, severe stridor, and production of phlegm for approximately 2 years. On admission to our tertiary care hospital, he developed complete obstructive apnea within an hour, and was intubated. A tracheal biopsy was performed, followed by resection. Histopathology confirmed chondrosarcoma of the trachea. The patient tolerated the procedure very well and is currently symptom-free on follow-up, with no signs of recurrence.

Background:Pheochromocytomas are catecholamine secreting tumors of the adrenal medulla chromaffin cells, however, when present extra-adrenally they are called paragangliomas. Paragangliomas rarely produce catecholamine in excess, which is evident by clinical symptoms, urine, and blood biochemistry. Total resection of these tumors can lead to complete clinical and biochemical resolution. This case report presents the clinical features, radiological findings, and neurological outcome in a middle-aged female with a secretory paraganglioma.Case Description:We present the case of a 34-year-old female who presented with a 2-year history of dizziness, flushing, headache, palpitations, and hypertension. Her blood workup showed raised urinary catecholamine levels. Magnetic resonance imaging (MRI) and iodine-123-meta-iodobenzylguanidine (MIBG) scans demonstrated a retroperitoneal mass located anterolateral to T11-T12 vertebral bodies reaching up to T12-L1 intervertebral disc. The patient was otherwise neurologically intact. She underwent resection of the tumor after alpha-adrenergic and beta-adrenergic blockade. En bloc resection was achieved without neurological complications. Postoperatively, the patient was initially hypotensive and subsequently became normotensive, and on follow-up, the patient had resolution of her symptoms and was stable.Conclusion:Secretory paraganglioma of the dorsal spine are rare and difficult to excise, needs preoperative preparation with pharmacological intervention, good operative technique, and postoperative care.

INTRODUCTION: Pulmonary hyalinizing granuloma (PHG) is a rare lung disease characterized by presence of single or multiple lung nodules. The disease is often asymptomatic and diagnosis requires histopathologic confirmation. PHG generally carries a good prognosis. Significant amelioration of respiratory symptoms is often seen with corticosteroids CASE PRESENTATION: A 40-year-old, housewife, with no known comorbids, presented with complaints of cough and shortness of breath for around 10 months. She reported that cough is mostly non-productive, associated with shortness of breath even on mild activity. She also mentioned low-grade fever with fatigue but no weight loss. She had a 10 pack years history of smoking. She denied joint pains, skin rash or ulcers. She had no family history of TB or lung cancer. On physical exam, her respiratory rate was 20 bpm, and SpO2of 99% on room air with no digital clubbing. There were normal vesicular breath sounds on chest auscultation. Chest X-Ray (fig. 1) showed bilateral multiple rounded opacities. CT chest (fig. 2A, 2B) revealed multiple nodules and masses of variable shapes and sizes. Investigations showed ANA positivity with fine speckled pattern but Anti-dsDNA, RA factor and ENA profile were negative. Bronchoscopy and BAL was offered but she refused. She then underwent CTguided biopsy (fig. 3A,3B,3C) that showed cores of fibrocollagenous tissue with dense keloid like collagen arranged in whorls with interspersed histiocytes and lymphocytes. Special stains including congo red, AFB, Periodic acid schiff diastase(PASD) were negative. She was diagnosed as Pulmonary hyalinizing granuloma. Marked clinical response was seen with corticosteroids within 3 weeks of initiation of treatment.DISCUSSION: PHG was first reported in 1964 by Benfield. The occurrence of this disease is linked to an exaggerated immune response to any infectious or autoimmune processes. Lhote et al. published a case series of PHG in 2016 and performed a detailed analysis of 135 cases of PHG published between 1964 and 2015. The results revealed that median age of presentation is usually 44 years with male gender predominance and the most common presenting symptom was cough being 44%. Conditions associated with PHG were wide in number including infections in 14.1%, autoimmune diseases in 12.1%, tumors in 4.4% and various other causes. CT-guided percutaneous biopsy of lesions is required to confirm the diagnosis. Radiographic improvement in the nodules was more frequent in patients treated with corticosteroids than patients without treatment ( 42.1% and 4.4 % respectively).CONCLUSIONS: PHG remains a unique nodular lung disease. It is a great mimicker of pulmonary metastases and tuberculosis. Hence this case signifies the histopathologic confirmation in all such cases where tuberculosis remains an endemic disease and a high probability of metastatic disease should not distract the clinician from rarities