Terms such as retrosternal, substernal, intrathoracic, or mediastinal have been used to describe a goitre that extends beyond the thoracic inlet. However, there is a lack of consensus regarding the exact definition of a retrosternal goitre (RSG).(1) The majority of patients present with shortness of breath or asthma like symptoms (68.8%), as was the case in the studied patient. Other modes of presentation include neck mass (75%), hoarseness of voice (37.5%), dysphagia (31.3%), stridor/wheezing (19%), or SVC obstruction. Upper airway obstruction due to thyroid gland has been reported up to 31%(2) and difficulty in intubation has been reported in 11%.(3) Central airway obstruction produces symptoms of dyspnoea, stridor, or obstructive pneumonia and is often misdiagnosed as asthma.(4) The CT scan was the most useful tool showing the nature and extent of the lesion in the reported case. In a recent publication, the CT scan was considered the gold-standard preoperative radiological investigation.(5) Surgery is the only effective treatment for retrosternal goitres. In most cases, suppressive therapy with thyroxine is ineffective in reducing the size of multinodular goitres;(7,8) radio-iodine therapy is both generally ineffective in large goitres(8) and may induce acute inflammation and swelling of the gland with the potential for airway obstruction. The operation of choice is usually a total thyroidectomy. Only around 2% of patients undergoing thyroidectomy for retrosternal goitre will require surgical access other than a standard collar incision (either manubriotomy, sternotomy or thoracotomy).(9) CONCLUSION: Despite all the advances in investigative modalities, retrosternal goitre still exists in 20% of patients over 70 years in endemic regions. It has to be recognised that it can be a cause of obstructive sleep apnoea. Early detection and prompt management goes a long way in decreasing the morbidity and mortality in patients with RSG.

Trace elemental analysis of hair samples from subjects suffering with cervical cancer before radiation therapy and at successive intervals during radiation therapy was carried out using the PIXE technique. A 2 MeV proton beam was employed. The elements Cl, K, Ca, Ti, Cr, Mn, Fe, Ni, Cu, Zn and Pb were identified and their relative concentrations were estimated. The concentrations of Cl, K, Ca, Ti, Cr, Mn, Fe, Ni and Zn were found to be lower in hair samples of cervical cancer patients before radiation therapy than those from controls, whereas the concentration of Cu showed the opposite trend. The concentrations of Cl, K, Ca, Ti, Mn, Fe, Cu, Zn and Pb showed a definite trend of variation with successive intervals of radiation therapy, which indicates that these elements are affected during radiation therapy. The Cu/Zn ratio also decreases with successive radiation therapy.

Gastrointestinal stromal tumours (GIST) are rare tumours arising from mesenchyme of gastrointestinal tract and overexpress C-kit protein. Mainly seen in stomach and small bowel. Mesenteric GIST are rarely reported as they constitute less than 1% of total GIST. We here report such a rare case of GIST arising from mesentery of small bowel and presenting as acute abdomen. Good surgical clearance ensures good survival whereas incomplete resection results in a high incidence of recurrences with distant metastasis.

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Cystosarcoma phyllodes is an uncommon neoplasm of the breast, constituting 0.3-0.9% of all breast tumors. The incidence of malignant phyllodes tumor is even lower. The tumor is similar to fibroadenoma in structure, but it is distinguished from it histologically by large leaf-like projections of stroma with increased stromal cellularity [1]. Although surgical removal is the mainstay of treatment, the extent of surgery required (excision vs. mastectomy) and the need for additional local therapy, such as radiotherapy, are unclear [2]. We report a case of a 35 year old married woman who presented to our out patient department with a fungating, foul smelling mass in the right breast that turned out to be a malignant phyllodes tumour. The malignant variant of the cystosarcoma phllodes tumour is indeed a very rare mammary tumour.