Epithelial ovarian cancer normally spreads transcoelomically via the peritoneal cavity and then, in more advanced stages, to the intra-abdominal lymph nodes and the liver and lung parenchyma. Bone metastasis is an extremely rare initial presentation in patients with primary carcinoma of the ovary and is associated with poor prognosis. Herein we report a rare case of femoral metastasis of papillary carcinoma of the ovary in a 49-year-old female, who presented to the orthopaedics clinic with complaints of pain and swelling around the left knee joint since 2 months. X ray and MRI of left leg showed a diffuse soft tissue swelling and osteolytic lesions in the lower femur around the condyles with focal cortical destruction. Fine needle aspiration biopsy of the lesion was suggestive of metastatic adenocarcinoma. Subsequent ultrasonography of the lower abdomen showed a hypoechoic shadow in the left ovary. Local surgical excision with left oopherectomy was performed. After histopathologic and immunohistochemical examination from both the sites, a final diagnosis of primary papillary adenocarcinoma of the ovary with femoral metastasis was given. She was treated with 6 cycles of adjuvant combination chemotherapy of Paclitaxel 150 mg/m 2 and Cisplatin 50 mg/m 2 and a good response was seen. This case is unique in presentation of bony femoral metastasis with silent epithelial ovarian carcinoma.

Adrenocortical neoplasms are rare tumours that can be diagnostically challenging in some cases. Numerous diagnostic algorithms and scoring systems are in practice to differentiate adenoma from carcinoma. Besides, the different histological variants of adrenocortical carcinoma need to be identified. We present a case of 44 year old female with vaginal bleeding with a large, heterogenous suprarenal mass on imaging. Provisional clinical diagnosis of pheochromocytoma was made and patient underwent adrenalectomy. The histological examination of tumour sections showed sheets and trabeculae of moderately pleomorphic cells with extracellular mucin deposition. Immunohistochemical evaluation showed tumour cells to be negative for chromogranin with focal pan cytokeratin positivity. Finally a diagnosis of adrenal cortical carcinoma-myxoid variant was made. Post operative period was uneventful and following en bloc resection of the tumour patient did not receive any adjuvant adrenolytic treatment. The patient is doing well at 6 months of follow up period, without any evidence of recurrence.

Papillary lesions of the breast include a broad spectrum of entities, many of which pose a diagnostic challenge for the pathologist. Papillary Carcinoma is a rare malignancy of the breast accounting for 0.5-2% of all breast carcinomas. It occurs more frequently in post-menopausal women over the age of 60. The most common presentation is a painless, mobile mass with bloody nipple discharge. Mammography typically shows a large circumscribed mass with an irregular or nodular contour. We present a case of a 42year-old-woman with a painless lump in the right breast for 11 months, diagnosed as encapsulated papillary carcinoma of breast with in-situ component.

Ocular sarcoidosis leads to inflammation of the eye, manifesting as uveitis, scleritis and conjunctivitis with granuloma formation. It can involve any part of the eye and its adnexal tissues, and may result in complications like glaucoma and cataract. Ophthalmic manifestations of sarcoidosis can be isolated, or it may be associated with other organs of the body. The clinical presentation in ocular sarcoidosis is quite varied. Multi-disciplinary modality of treatment is required for both ocular and systemic manifestations of the disease. We report a rare presentation of solitary ocular sarcoidosis in a 42-year-old woman, who presented with complaints of painless left inner canthus swelling and blurry vision for 1 month.

Primary signet-ring cell carcinoma (SRCC) of vermiform appendix is extremely rare. A 62year-old man presented to the Surgical Clinics with right lower abdominal pain, where he was diagnosed with acute appendicitis based on the history and examination with hematologic investigations and computed tomography. Appendectomy specimen grossly showed acute inflammation with appendiceal adhesions and body of the appendix showed wall thickening and luminal occlusion. Microscopically nests of carcinoma cells were seen with compressed nuclei and intracytoplasmic mucin invading into the muscular layer. No lymphovascular permeation was seen. The cut margins were negative for carcinoma cells.Immunohistochemically, SRCC cells were positive for cytokeratin (CK) AE1/3, EMA, CEA, MUC2, and high Ki-67 labeling index. They were negative for CK5/6, CK7, Vimentin, MUC1 and chromogranin. Our patient is fine after 6 months of follow up, with no evidence of recurrence or metastasis.