Hepatoid adenocarcinoma of the stomach is a rare form of gastric carcinoma with specific clinicopathological features and extremely poor prognosis. Here, we report a case of a 60-year-old male patient who presented in the outpatient department with pain abdomen and constitutional symptoms. Radiological examination revealed a growth involving the antrum of the stomach while the liver and spleen were normal. The serum alpha fetoproteins were 6590 ng/ml. The patient underwent a partial gastrectomy and microscopic examination of the growth showed two types of histological patterns. Majority of the tumor displayed hepatoid differentiation with adenocarcinomatous foci. Periodic acid Schiff positive intracytoplasmic hyaline globules were seen. The tumor was immunohistochemically positive for alpha fetoprotein. The patient underwent radical gastrectomy, received chemotherapy and has been on follow-up for the past 12 months. Though known to be an aggressive neoplasm early diagnosis of hepatoid adenocarcinoma can help improve the prognosis of the disease.

Metaplastic carcinomas of breast are uncommon, representing 0.3% of invasive carcinomas of breast. We are reporting two cases of metaplastic carcinoma breast, one revealing rhabdomyoblastic and spindle cell differentiation and other revealing osteoclast like giant cells. Both were estrogen receptor, progesterone receptor and Her2u negative on immunohistochemistry. Early diagnosis of metaplastic carcinomas is essential as these tumors are usually triple negative and hence, do not respond to transtuzumab. Metaplastic carcinomas typically express HER1/epidermal growth factor receptor (EGFR), thus majority of metaplastic carcinomas are treated with EGFR inhibitors such as geftinib and cetuximab. Also, metaplastic carcinomas are associated with a worse prognosis with a disease free survival rate being 78.1% in metaplastic breast carcinomas compared with 91% in infiltrating duct carcinomas.

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Letters to Editor non-availability of medical staff. In one of the study, it was indicated that 143 public facilities found absenteeism of 45% doctors from PHCs with 56% of time found to be closed with an unpredictable pattern of closure and absenteeism during regular hour visit. [2] A survey report from Madhya Pradesh in 2007 states that out of 24,807 qualified doctors and 94,026 qualified paramedical staff mapped in the survey in the state, 18,757 (75.6%) and 67,793 (72.1%) were working in the private sector respectively highlighting the government failure to provide basic infrastructure to doctors and other health care workers in rural areas. [7] This could be tackle by focusing on skill up gradation, capacity development and capability reinvigoration and limiting the scope for practice of illicit and unqualified practitioners. Thus, primary health care in India needs to be re-evaluate and immediately warrants reforms and concrete steps to be taken, otherwise this tug of war between growth and human resource development remains will continue forever.

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