Schwannomas are benign nerve sheath tumors and are most frequently encountered as soft tissue tumors of peripheral nerves of the head and neck or the extensor extremities. Osseous involvement is very uncommon with fewer than 200 cases described in the world literature, the majority of which arise in the skull (including mandible), vertebrae, and sacrum. Long bone involvement is highly unusual and of the approximately 20 cases described thus far, only five have been documented to arise in the femur. We describe an unusually large schwannoma of the femur which was discovered incidentally and was diagnosed only after biopsy, given the rarity of this tumor at that particular site. Following prophylactic internal fixation and bone grafting, our patient remains well and disease-free, 2.5 years later.

The occurrence of acute oxalate nephropathy (AON) as a result of consuming foods rich in oxalates is well -recognized. Although renal injury has been extensively recognized and described following the ingestion of star fruit (Averrhoa carambola), reports implicating ‘bilimbi’ (Averrhoa bilimbi), are far less common and were found in adults following ingestion of bilimbi juice. This report describes possibly the first case of AON occurring in an otherwise healthy eight year old boy following the consumption of several bilimbi fruit. Features which favoured dietary hyperoxaluria as the cause for his acute renal injury included the development of acute gastro-intestinal symptoms after ingesting the oxalate rich fruit, the presence of oxalate crystals in the urine full report and renal biopsy and the episodic reversible nature of his illness. Dehydration is likely to have contributed to his AON. The patient was managed medically, did not require dialysis and recovered completely within two weeks. It is important to note that dietary hyperoxaluria causing oxalate nephropathy may be an under-recognised cause of renal disease.

Journal of Diagnostic Pathology is a peer reviewed journal published biannually by the College of Pathologists of Sri Lanka. The journal publishes manuscripts dealing with all aspects of pathology. The aim of the journal is to update knowledge and encourage original research in the field of pathology.

BACKGROUND:Heterotopic pancreas is a rare congenital condition characterised by pancreatic tissue lacking vascular or anatomic communication with the normal pancreas. Most cases of ectopic pancreas are asymptomatic. The preoperative diagnosis of this condition is difficult.CASE PRESENTATION:A 50-year-old woman presented with dyspeptic symptoms of 4 years duration. Contrast enhanced CT (computed tomography) scan of abdomen suggested a gastrointestinal stromal tumour in the fundus of the stomach. The patient underwent laparoscopy assisted resection and subsequent histology revealed ectopic pancreatic tissue.CONCLUSION:Although heterotopic pancreas is a rare lesion diagnosed on histology, it should be considered in the differential diagnosis of gastric mass lesions and in patients presenting with vague upper gastrointestinal symptoms.

Journal of Diagnostic Pathology is a peer reviewed journal published biannually by the College of Pathologists of Sri Lanka. The journal publishes manuscripts dealing with all aspects of pathology. The aim of the journal is to update knowledge and encourage original research in the field of pathology.

Hepatocellular carcinoma (HCC) is among the commonest cancers in the world. Metastasis is one of the most significant factors affecting prognosis. Common sites of extrahepatic metastases include lungs, regional lymph nodes and less commonly bone.

Journal of Diagnostic Pathology is a peer reviewed journal published biannually by the College of Pathologists of Sri Lanka. The journal publishes manuscripts dealing with all aspects of pathology. The aim of the journal is to update knowledge and encourage original research in the field of pathology.

CONTEXT Pancreatic desmoplastic small round cell tumour (DSRCT) is an extremely rare malignancy of which very few reports exist. It follows an aggressive course and has a dismal prognosis. CASE REPORT A twenty-four-year-old male presented with a one-month history of rapidly progressive obstructive jaundice associated with abdominal pain suggestive of a biliary colic. Contrast-enhanced CT (CECT) of the abdomen revealed a pancreatic head mass. He underwent a pancreaticoduodenectomy and adjuvant chemotherapy and is disease free one year after surgery. CONCLUSION This is the first reported case of a pancreatic head DSRCT, discovered in a young male investigated for a short history of painful obstructive jaundice.

Journal of Diagnostic Pathology is a peer reviewed journal published biannually by the College of Pathologists of Sri Lanka. The journal publishes manuscripts dealing with all aspects of pathology. The aim of the journal is to update knowledge and encourage original research in the field of pathology.

INTRODUCTION:Burkholderia cepacia is widely prevalent in nature. The natural habitat of this organism is soil, water and vegetation, but the hospital environment remains the main source of infection. It causes a wide variety of infections in hospitalised patients. Since there are no reports of its prevalence in Sri Lanka, a data retrieval and analysis was undertaken to determine its incidence among patients at Sri Jayawardenepura General Hospital (SJGH).OBJECTIVE:To determine the prevalence, morphological characteristics, biochemical profile and antibiotic susceptibility pattern of B cepacia in a Sri Lankan tertiary care hospital.METHODS:Relevant clinical data were retrieved from all isolates of B cepacia from SJGH for 12 months from October 1996. Standard procedures were used to isolate the organism from clinical specimens. API 20E was employed for biochemical identification. Antibiotic susceptibility tests was carried out using the modified Kirby Bauer method.RESULTS:B cepacia was isolated from 17 patients. 16 of them were hospitalised and were from the medical, surgical, and intensive care units. All were in a compromised state of health. The organism was isolated from a variety of specimens which included swabs of surgical wounds, chronic ulcers, sputum, bronchial lavage, endotracheal aspirate, urine, peritoneal fluid and blood. Blood agar, MacConkey agar and cystine lactose electrolyte deficient medium supported the growth of all strains. They were motile Gram negative rods. All strains were oxidase positive. Strains gave variable results with other biochemical tests. Antibiograms too were variable. All strains were sensitive to ceftazidime, and the majority of the strains were sensitive to the other third generation cephalosporines. All strains were resistant to four or more antimicrobial agents included in the study. Of the 17 patients from whom B cepacia was isolated, only 9 seem to have had actual infection; others were probably instances of colonisation or contamination.CONCLUSIONS:The present report confirms the prevalence and importance of B cepacia as a hospital pathogen in Sri Lanka. Hospital laboratories should be equipped to isolate, identify and perform antibiotic sensitivity test on these strains. Antibiotic susceptibility testing is necessary as the patterns seem to differ among strains. The multiple drug resistant nature of the organism warrants strict infection control measures to prevent spread in a hospital setting.