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Background: Polycystic ovarian syndrome [PCOS] is a complex ill understood hormonal disorder resulting in myriads of symptoms like irregular menses, hyperandrogenism, metabolic disturbances and infertility. It occurs in about 8-11% of reproductive age group women. Recently changing lifestyles and rising obesity worldwide have contributed to rise in the incidence of PCOS. Objective of the present is to study the prevalence and symptomatology of PCOS in Indian women.Methods: 170 women in reproductive age group, with irregular menstrual cycles attending OPD, voluntarily participated in a cross sectional study. All were subjected to detailed history, examination and investigated with a battery of lab tests to confirm PCOS. Out of 170 women investigated 70 women with features of PCOS were included in the study (diagnosed as PCOS by NIH criteria).Results: The overall prevalence of PCOS in the study population was, 41%. It was 16% in married women and 24 % in unmarried girls. Common menstrual irregularity was-oligomenorrhea (40%), Menorrhagia (12.8%) amenorrhea (11%). Common symptoms were hirsutism, acne, infertility and alopecia.Conclusions: PCOS is rising in young women and to some extent the changing lifestyle in urban women may be linked to it. There in a world-wide increase in the incidence of obesity, diabetes mellitus and metabolic syndrome, PCOS and its accompanying insulin resistance is contributing to it. Treating PCOS and its complications is adding to health care burden.

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A 35-year-old man presented with rapidly progressive symptoms of difficulty in breathing and speech and change in the voice for the past 2 weeks followed by a swelling in the mouth for 2 days. He also gave a history of chewing tobacco for the past 3 years. There was no other significant history. On examination, the swelling was in the oropharyngeal region on the right side of the palate, measured 2 · 2 cm in size and was firm, well defined and non-tender. The overlying mucosa was normal. Fine needle aspiration cytology (FNAC) of the mass was advised. MethodsFNAC was performed using a 22-gauge needle; the aspirate was processed as air-dried Giemsa-stained smears. Cytomorphological features were suggestive of adenoid cystic carcinoma (ACC). The mass was excised; the histopathological diagnosis was of classical intravascular papillary endothelial hyperplasia (IVPEH). For confirmation of the diagnosis, a panel of immunohistochemical (IHC) markers was performed on the surgical specimen: vascular markers (CD34) to confirm IVPEH and myoepithelial markers (S100 and cytokeratin) to rule out ACC. Results Cytological findingsCytological smears showed high cellularity comprising predominantly small round cells in clusters, or with a small acinar pattern surrounding hyaline globules, and cord-like material in most places. There was focal mild pleomorphism without mitoses, and no necrosis in the background (Figure 1). The cytomorphological features were reminiscent of salivary gland ACC, which was the initial cytological diagnosis. Histological findingsSections from the excised mass showed a dilated vessel with intraluminal growth. The lumen was filled with organizing thrombi with classical features of IVPEH. The mass consisted of anastomosing vessels with a prominent papillary pattern. The endothelial cells in these papillae surrounded hyaline cords and globules in many places, as seen in the FNA smear ( Figure 2). There was no pleomorphism or mitotic activity, and no necrosis in the background. ImmunohistochemistryOn IHC the cells showed strong cytoplasmic positivity for CD34, confirming the histological diagnosis of IVPEH, and were negative for S100 and CK: this ruled out the possibility of ACC.FNA smears were reviewed after the histological diagnosis of IVPEH; it was found that the globules and cord-like basement membrane material secreted by endothelial cells in PEH had been misinterpreted on cytology as hyaline globules and cords of ACC. In many places, the proliferating vessels could be well appreciated: the plump endothelial cells were in close proximity to this hyaline material and were seen abutting it, forming new blood vessels (Figure 1a-c).

Thus serial casting is a very simple, safe and cost effective procedure which can be applied even in children with mental sub normality having all three major joints involved bilaterally.