Mucormycosis, an angioinvasive fungal infection caused by fungi of the order Mucorales, presents a significant health burden especially after COVID-19 epidemic. The most common clinical manifestation is rhino-orbital-cerebral mucormycosis (ROCM), primarily affecting immunocompromised patients [1]. Diagnosis involves recognizing risk factors, evaluating clinical manifestations, employing imaging modalities, and performing histopathology and cultures. Hot et al. (2010), in their prospective study has demonstrated the potential of [18 F]FDG-PET in the initial and residual staging of invasive fungal infections (IFIs), showing superior detection rates compared to conventional CT. Similarly. Douglas et al. (2018) reported FDG PET-CT localizes clinically occult infections and track response to antifungal therapy more effectively than CT. PET-CT’s ability to detect active metabolic changes, reflecting inflammatory cell activity, emphasizing its potential in detecting residual disease. The present prospective study aims to evaluate PET-CT’s efficacy in assessing residual disease in postoperative mucormycosis patients, which was conducted on 51 postoperative mucormycosis patients at a tertiary healthcare center in Delhi over 12 months (2022–2023). Inclusion criteria were post-surgical debridement cases of mucormycosis, with exclusions for intracranial disease, deranged kidney function, and uncontrolled DM. PET-CT scans were performed six weeks post-surgery. Data were then compared with operative procedures performed. The study population’s age ranged from 24 to 80 years, Surgical procedures included subtotal maxillectomy, inferior maxillectomy, medial maxillectomy, and total maxillectomy. PET-CT detected residual disease in 49

Endometriosis is a benign gynecological condition that commonly affects women of reproductive age. It is characterized by the presence of ectopic endometrial tissue, predominantly within the pelvic cavity. Ovarian endometriosis usually presents as an endometrioma with typical clinical and radiological features. However, atypical presentations such as varied symptoms, elevated tumor markers, and inconclusive imaging often complicate the differentiation between benign and malignant ovarian masses. This poses significant diagnostic challenges, which can be addressed with the use of intraoperative frozen sections. We hereby report a case of infiltrative endometriosis that presented with clinical features, radiological findings, and elevated serum tumor markers suggestive of ovarian malignancy.

We report a rare case of penile papulonecrotic tuberculid (PNT) in a middle-aged male with idiopathic interstitial lung disease (ILD) on chronic steroids, presenting with recurrent, painless genital ulcers. Systemic evaluation revealed disseminated tubercular lymphadenitis as the primary focus. The patient was diagnosed with PNT based on clinical and histopathological findings, and tuberculosis was confirmed through imaging and cytology. This case highlights the diagnostic challenge of penile PNT, particularly in immunosuppressed individuals, and underscores the importance of comprehensive tuberculosis screening in patients with tuberculids, especially those with underlying chronic conditions like ILD.

Androgen insensitivity syndrome (AIS) is a rare disorder of sexual development. Patients present clinically with a varied phenotypic presentation depending on the residual androgen activity, which can be complete, partial, or mild. Karyotyping is helpful in the diagnosis of AIS. A suspicion of AIS should be considered in any female child presenting with inguinal swellings or labial edema. This report presents a case of this rare disorder in an 18-year-old unmarried girl who failed to achieve menarche. Tanner staging was performed, revealing a Tanner stage 4 for breast development and stage 2 for pubic hair. Clinical examination revealed bilateral inguinal swelling, clitoromegaly, and a blind-ending vagina. Radiological investigations additionally revealed the absence of the uterus and bilateral adnexal structures. Karyotyping was performed, which showed a 46,XY genotype. A surgical specimen was sent for a frozen section, which revealed fibro-collagenous tissue, blood vessels, epididymis, and hyalinized seminiferous tubules. Routine histopathological examination confirmed the absence of spermatogenesis and ruled out any neoplastic lesions. These findings were suggestive of complete AIS. This article highlights the pivotal role of frozen section in the diagnosis of such cases and emphasizes the importance of histopathological examination to rule out additional neoplastic etiology.

Objective To evaluate role of rajyoga meditation (RYM) versus stress management counselling (SMC) in addressing burnout syndrome and resultant improvement in electrocardiogram (ECG) so as to automate burnout prediction from raw ECG data with machine learning (ML). Methods Healthcare providers were assigned to two groups: RYM (n=100) or SMC (n=102). Subjects in RYM received rajyoga for 3 months including one week offline and thereafter, virtual mode. SMC group received counselling for 1 day in offline mode and thereafter, received positive thoughts on a weekly basis. All subjects were assessed for psychological (depression, anxiety, stress scale-21 (DASS-21) and burnout syndrome (Mini Z questionnaire) along with 12-lead ECG at baseline after 4 weeks, and after 12 weeks. Based on response on question 3 of the Mini-Z questionnaire, participants were classified either as burnout or satisfied. Results RYM group showed significant reduction in depression, anxiety, and stress in comparison to SMC group. Burnout results display significant reduction in the RYM group in comparison to SMC group. Reduction in burnout and enhancement in satisfaction from visit-1 to visit-3: burnout visit-1 (27.2%), visit-2 (23.8%), visit-3 (19.3%) and, satisfaction visit-1 (72.8%), visit-2 (76.2%), and visit-3 (80.7%). ML algorithms could identify burnout patients using the raw ECG data with time-series features based classifier performing better than Ultra Short HRV features based ML classifier model. Conclusion AI based early diagnosis of heart’s healthy status using ECG analysis may prevent development of cardiovascular disorder in the long run.

ABSTRACT:Pleomorphic adenoma usually presents as a painless growing mass in locations of the salivary glands and is notorious for local recurrence if previous surgical resection is incomplete. Schwannoma is a benign peripheral nerve tumor with microscopic features of sheets of spindle-shaped cells with nuclear palisading. However, when a pathologist encounters a salivary gland tumor with microscopic morphological features of biphasic components with areas of schwannoma-like morphology, it is crucial to make a prudent diagnosis by differentiating Schwannoma-like pleomorphic adenoma and its differential diagnosis as they have remarkably different outcome in patients. We herein present a case of Schwannoma-like pleomorphic adenoma and discuss its approach to diagnosis and literature search.

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the abdomen. Most of these tumors occur in the stomach. They arise from the interstitial cells of Cajal. GIST usually occurs in adults of more than 50 years of age, with a median age of 62–63 years. Fewer than 10% of cases occur at <40 years of age. It commonly presents as exophytic growth. GIST may lead to symptoms due to the effect of the mass. Mucosal ulceration may cause blood loss leading to anemia. Asymptomatic GIST may be discovered as an incidental finding during imaging or endoscopy. Intraluminal GIST presenting clinically as intussusception is extremely rare. This case report presents a case of intestinal GIST in a 35-year-old man. The tumor presented as an intraluminal nodule leading to intussusception. A complete resection of the tumor was done. Histopathological examination with immunohistochemistry helped to arrive at a definite diagnosis and determine the prognosis.

This is the case of a 52-year-old Indian lady who presented with hematemesis, severe anemia, and an abdominal lump in cardiac failure. On radiographic evaluation, the lesion appeared to be gross circumferential asymmetric proximal gastric wall thickening, with suspicion of gastric lymphoma or tubercular hypertrophic gastritis. After stabilization with multiple transfusions, she underwent proximal D2 gastrectomy with esophago-gastric anastomosis and a total splenectomy. Grossly, the gastric rugae appeared to be hypertrophied and firm. No growth was identified grossly; however, necrotic areas were identified at the distal end. Microscopic examination of multiple sections studied showed significant foveolar hyperplasia, tortuous glands, and a few cystically dilated foveolar glands, which were limited up to the muscle layer. Mild serosal congestion was seen. No atypia or invasion was seen. An impression to consider is the possibility of Ménétrier's disease (MD). MD is an acquired protein-losing enteropathy with giant gastric rugal folds, decreased acid secretion, and increased gastric mucous production. Radiographically, endoscopically, and grossly, the condition can be confused with malignant lymphoma or carcinoma. It is difficult to diagnose, and histopathological confirmation of the resected specimen is needed for a definitive diagnosis. Our intention in presenting this case is to emphasize that MD can present as massive hematemesis and should be considered in a differential diagnosis. Surgical treatment by total or partial gastrectomy is recommended for cases with persistent, debilitating symptoms or a risk of cancer.

Cutaneous leiomyomas are benign and rare smooth muscle tumors. Genital leiomyoma includes leiomyomas located in the nipple, scrotum, areola or vulva. Nipple leiomyomas are the least common genital leiomyomas and are commonly seen to occur in middle-aged women. Here, we present a case of a 40-year-old female complaining of a growth over the right nipple for six months. On local examination, it was a 1cm x 1cm growth on the lateral aspect of the nipple. Finally, a treatment plan of complete excision was done. Grossly, it was a well-circumscribed skin-covered soft tissue bit with a skin flap measuring 0.6cm x 0.6cm and soft tissue measuring 0.6cm x 0.5cm x 0.2cm. Histopathological examination revealed a skin-covered section with dermis showing a well-circumscribed unencapsulated lesion that showed intersecting fascicles of spindle cells with no atypia or mitoses noted. Microscopically, the growth had tumor-free resection margins. Immunohistochemical confirmation with S100, smooth muscle actin (SMA) and caldesmon was done. Diagnosis of nipple leiomyoma was given with strong SMA positivity. Nipple leiomyoma is a rare, benign lesion and needs to be correctly diagnosed microscopically. Biopsy and immunohistochemistry is a confirmatory investigation that can lead to timely management of the patient.

Background: Endometrial stromal tumors (ESTs) are rare subset of mesenchymal uterine neoplasms. There are heterogeneous morphological, immunohistochemical, and genetic features. Approximately 50% of ESTs occur in perimenopausal women. In 2020, WHO sub-categorized ESTs into four groups: endometrial stromal nodule (ESN), low-grade endometrial stromal sarcoma (LGESS), high-grade endometrial stromal sarcoma (HGESS), and undifferentiated uterine sarcoma (UUS). Objective: To review the morphological spectrum of endometrial stromal tumors. Method: This retrospective study reviewed the histomorphological features of 15 endometrial stromal tumors with respect to atypia, necrosis, mitosis, collagen bands, whorling around vessels, myometrial invasion, and inflammatory cells. Immunohistochemistry markers (CD10, SMA, and ER) along with special stains (Masson’s trichrome, toluidine blue) were also studied. Results: The age of the patients ranged from 32 to 60 years. Three patients were postmenopausal. The most common presenting symptom was vaginal bleeding. Five patients were operated with a clinical diagnosis of uterine fibroid. One patient presented with prolapse with no other complaint. All the 15 patients had total abdominal hysterectomy and salpingo-oophorectomy. One case showed necrosis, eight cases showed collagen bands, all the 15 cases showed whorling around vessels, one case showed vascular emboli, and seven cases showed inflammatory cells. In low-grade cases, one case showed focal atypia and one case showed focal coagulative necrosis indicating infarction. Thirteen cases were LGESS, and one case of ESN and HGESS. All cases were positive for ER and CD10. Conclusion: Endometrial stromal tumors demonstrate extensive permeation of the myometrium as irregular islands with frequent vascular invasion, whorling around vessels, collagen bands, and inflammatory cells. All these features should be observed thoroughly on microscopy by pathologists to clearly differentiate the low-grade and high-grade endometrial stromal tumors, and to understand the overlapping gray areas morphologically as it affects the prognosis of the patient.

ABSTRACT:Granular cell tumors (GCTs) are uncommon soft tissue tumors, which are difficult to diagnose merely by clinical examination. Fine-needle aspiration cytology (FNAC), being an effective first-line investigation, plays a significant role in the preoperative diagnosis of GCT. However, the tumor can mimic certain other lesions; hence, a cytopathologist needs to be aware of its characteristic morphology. We report here a case of GCT, presented as a subcutaneous nodule in the first finger web. A differential diagnosis of lipoma/neurofibroma was made clinically. FNAC was done and showed characteristic features of granular cell tumor along with intranuclear inclusions and subsequently, it was confirmed on histopathology.

ABSTRACT:Bizarre parosteal osteochondromatous proliferation (BPOP) is also known as Nora's disease. It is a benign lesion. Even though recent studies showed probable neoplastic etiology, the exact cause is unknown. BPOP commonly involves small bones of hands and feet. This condition is rare and very few cases are reported. In this report, two cases are presented with clinical, radiological, and histopathological findings. The first case was a 38-year-old female presented with 3-year history of mild painful swelling in the left middle finger and the second case was a 28-year-old male with the left leg swelling for 8 years. On radiology, both cases showed surface lesion with uninvolved medullary cavity. Excision specimen of both the lesions subjected for histopathological examination. Microscopically, there was irregular maturation of the bone and cartilage. Cartilage showed purplish-blue color (blue bone) with bizarre chondrocytes. BPOP is a rare benign condition. Awareness of clinical radiological and microscopic findings is needed for correct diagnosis and to differentiate it from other mimicking benign and malignant conditions.

Introduction: Cancer stem cells (CSC) within the tumors play a central role in tumorigenesis. It is, thus, of utmost importance to identify these cells to develop effective cancer therapy. Triple-Negative Breast Cancer (TNBC) is an aggressive molecular subtype of breast cancer associated with poor patient outcomes. The role of CD44 immunohistochemistry (IHC) as a putative CSC in breast carcinomas, particularly of the TNBC-subtype is ambiguous, with equivocal results. Aims and Objectives: The present study aims to assess the role of CSC in breast carcinoma by immunohistochemical analysis of CD44 expression in TNBC. The association of TNBC expressing CSC with histological grade as well as with angiogenesis (using CD34 IHC) has been studied. Materials and Methods: Biopsy samples from 58 patients with infiltrating ductal carcinoma, NST were studied. The histology of the tumor was sub-classified into grades 1–3. Based on immunohistochemical analysis (ER, PR, HER2/Neu), the cases were divided into TNBC and NTNBC groups. The tissue sections were also subjected to analysis for CD44 to identify the CSC-phenotype and CD34 to evaluate angiogenesis, to determine the microvascular density (MVD). Results: Out of the 58 cases in the study, 28 were TNBC and 30 were NTNBC. CSC phenotype (CD44 positive) was expressed significantly higher in the TNBC (78%) versus the NTNBC (53%) (p-value 0.043). The MVD estimated using CD34 IHC was lower in the TNBC group in our study, though the difference was not statistically significant. A larger proportion of cases in TNBC showed a higher histological grade (35%) in comparison to NTNBC (27%). However, statistically, it was not significant. Conclusion: Our study demonstrated that CD44 as a CSC marker is seen significantly more in the TNBC category of invasive ductal carcinomas. Further large-scale studies, to confirm these findings, will be of potential therapeutic and prognostic value.

Background:Colorectal carcinoma (CRC) is third most common malignancy in the world. The presence of Lymphocytes particularly at the invasive margin of the tumor have been associated with good immune response indicating better prognosis. The relative tumor stroma is also important in deciding the course of the disease. The Glasgow Microenvironment Score (GMS) comprises of assessment of tumor cell infiltrate using Klintrup-Makinen (KM) grade and tumor stroma percentage. Aims:The aim of the present study is to evaluate the utility of GMS score in relation to parameters of adverse histopathological outcome in carcinoma colon that is grading, staging, LVI, PNI and nodal metastasis. Setting and Design:Colectomy specimens received over 3 year period were subjected to microscopic evaluation for LVI, PNI, grade, stage & lymph node metastasis. Materials and Methods:Lymphocytes at the deepest invasive margin of tumor were counted as per KM score in 5 HPF by two independent pathologists . Patients were classified as Low grade (0/1) or high grade (2/3) response. Tumor stroma percentage was calculated as stroma poor (<50%) and stroma rich (>/= 50 %). The GMS was scored by combining the two and scored 0, 1 and 2. Statistics and Results:Total 37 patients with no prior therapy were included out of which 23 were males and 14 females. 15 patients (40.54%) had GMS of 0, 6 (16.21%) had GMS 1 and 16 (43.24%) had GMS 2. A high GMS was associated with LVI (P = 0.02), PNI (P = 0.01) lymph node metastasis (P = 0.003). However, no significant association was found between GMS with Grade (P = 0.98) and Stage (P = 0.36). Conclusion:Low GMS was associated with good outcome and high GMS with poor outcome. This score can be used for risk stratification, can be of clinical utility and may be applied to pathological descriptions of CRC.

A rare extragonadal mixed germ cell tumor of the sacrococcygeal area presenting with mature thymic tissue in the teratomatous component, a rare finding and the first reported case of such an association.