BackgroundWe present a case of Xanthogranulomatous pyelonephritis (XGPN) in a male child with renal vein thrombus extending into the inferior vena cava. This is a rare presentation. XGPN is a rare type of renal infection characterised by granulomatous inflammation with giant cells and foamy histiocytes. The peak incidence is in the sixth to seventh decade with a female predominance. XGPN is rare in children.Case presentationAn 11 year old male child presented with a history of high grade fever and chills, right flank pain and progressive pyuria for two months. He had a history of vesical calculus for which he was operated four years back. In our case, a subcapsular right nephrectomy was performed. The surgical specimens were formalin fixed and paraffin embedded. The sections were stained with routine Hematoxylin & Eosin stain. Grossly; the kidney was enlarged with adherent capsule and thickening of the perinephric tissue. The pelvicalyceal system was dilated and was filled with a cast of pus. Histological evaluation revealed diffuse necrosis of the renal parenchyma and perinephric fat. Neutrophils, plasma cells, sheets of foamy macrophages and occasional multinucleate giant cells were seen. The renal vein was partially occluded by an inflammatory thrombus with fibrin, platelets and mixed inflammatory cells. The thrombus was focally adherent to the vein wall with organization.ConclusionsThe clinical presentation and the macroscopic aspect, together with the histological pattern, the cytological characteristics addressed the diagnosis towards XGPN with a vena caval thrombus. Our case illustrates that the diagnosis of XGPN should be considered even in paediatric age group when renal vein and vena caval thrombi are present.

The myelodysplastic Syndromes (MDS) are a group of clonal hematopoietic stem cell diseases characterized by cytopenia(s), dysplasia in one or more of the major myeloid cell lines, ineffective hematopoiesis, and increased risk of development of acute myeloid leukemia. The classification and the diagnostic criteria have been redefined by the recent World Health Organization Classification of Tumors – International Agency for Research on Cancer for Hematopoietic and Lymphoid Tissues. The myelodysplastic syndromes are now classified into the following categories – refractory cytopenia with unilineage dysplasia, refractory anemia with ring sideroblasts, refractory cytopenia with multilineage dysplasia, refractory anemia with excess blasts, myelodysplastic syndrome associated with isolated del (5q), myelodysplastic syndrome – unclassifiable, and childhood myelodysplastic syndrome. The clinicopathologic features, morphology, differential diagnosis, immunophenotyping, cytogenetics, prognosis and predictive factors are presented in the light of recent World Health Organization Classification of Tumors – International Agency for Research on Cancer.

We present a case of basal cell adenocarcinoma (BCAC) in the tongue in a 65-year old male. This is an extremely rare presentation. BCAC generally occurs in the parotid gland and rarely involves the minor salivary glands. Few cases have been reported in literature with a variable presentation. The biopsy was formalin-fixed and paraffin-embedded. The sections were stained with routine Hematoxylin and Eosin. Immunohistochemistry was performed. Hematoxylin and eosin staining showed tumour composed of variable sized and shaped, nests and sheets of basaloid epithelial cells having hyperchromatic to vesicular nuclei. Immunohistochemistry was positive for Pancytokeratin, Epithelial membrane antigen and p53. The clinicopathological features and the cellular immunophenotype addressed the diagnosis towards BCAC of the tongue. The goal of this report is to increase awareness of this rare disease and to review and discuss the differential diagnosis and important considerations in treatment.

Gall Bladder (GB) diseases are one of the most common digestive system diseases, the prevalence of which is variable within India and ranges from 2-29%. Cholelithiasis (gallstones) is the commonest lesion and accounts for more than 95% of GB diseases. Gall bladder carcinoma showed regional differences in India with prevalence ranging from 0.52% in southern India and as high as 9.6% in northern India. 1)To identify the morphological spectrum of diseases affecting the gall bladder. 2)To identify the most common histopathological lesion and its correlation with clinical and demographic data of the patient. 3)T o identify the frequency of Gall Bladder Carcinoma (GBC) and its correlation with clinical and demographic data of the patient and pre-existing lesions if any. This study was non-participatory descriptive study carried out retrospectively for a period of one year in the Dept. of Pathology, HIMS,from August 2018 to July 2019. All the specimens received in the study period were included in the study. The gross and microscopic findings on H & E slide were included in the study. The descriptive statistics w as applied to analysed data. Total 86 cholecystectomy specimens were received in the Department of Pathology during one year study period. Non-neoplastic lesions (97.67%) of gall bladder outnumbered the neoplastic lesions (2.33%). Most common histopathological lesion was chronic cholecystitis (95.34%). Varied histopathological spectrum was seen comprising of chronic calculous cholecystitis (73.26%), chronic acalculous cholecystitis (13.95), chronic cholecystitis with cholesterosis (13.95%), Xanthogranulomatous cholecystitis (2.33)%), Acute calculous cholecystitis (1.16%), acute gangrenous GB (1.16%), GBC (2.33%). In non-neoplastic lesions, female predilection (70.24%) was seen over male (29.76%) accounting for F:M ratio of 2.4:1, two cases of GBC exclusively seen in females associated with gall stones. Non-neoplastic lesions were common between the age group of 26-50 years accounting for 67.45% where as neoplastic lesions were common in the age group of >60years. Chronic cholecystitis with pigmented gall stone was the commonest GB disease in the present study. The study also revealed that females have increased preponderance for the development of all the gall bladder diseases including malignancy. Non-neoplastic lesions were more common till 5 decade in the present study whereas females in the 5th and 6th decade of life were prone for malignancy of gall bladder which was associated with gall stones.

Background: Breast cancer is the one of the leading causes death in women. Triple test approach has been widely accepted in asymptomatic women for the preoperative diagnosis of the breast lesions. Triple test includes clinical examination, mammography and Fine Needle Aspiration Cytology (FNAC) to differentiate between neoplastic and non-neoplastic lesions, histopathological confirmation being the gold standard for neoplasticlesions and best management plan for the patient.The aim was to study the histopathological spectrum of breast lesions and correlate the cytological and radiological findings with histopathological examination and to determine sensitivity, specificity and diagnostic accuracy of FNACand mammography in the diagnosis of the breast lesions. Methods:The study comprised of 552 casesofhistopathologically diagnosed breast lesions over the period of twelve years in a rural tertiary health care centre catering rural population. Results:Of the 552 cases examinedhistopathologically, 375 cases (67.9%) were benign lesions, 177 cases (32.1%) were malignant. Fibroadenoma was the commonest benign lesion, whereas infiltrating ductal carcinoma was the commonest malignant tumour. Incidence of phyllodes tumour was significantly higher compared to other studies. Overall sensitivity, specificity and diagnostic accuracy of FNAC and mammography were 95.9%, 98%, 96.6% and 84.7%, 78.5%,81.1% respectively. Conclusion:Histopathology plays an important role in diagnostic and therapeutic management of neoplastic breast lesionswith preoperative Triple test being an important supportive investigation in rapid diagnosis withfairly good sensitivity,specificity and diagnostic accuracyin neoplastic lesions. Significantly higher incidence of phyllodes tumor needs further investigation for causative mechanism.