A constellation of clinical, serological, endoscopic and histopathologic features is essential in diagnosing CD and autoimmune duodenitis. Biopsy is also a useful tool in diagnosing infectious duodenitis that are missed in other investigations.

Multiple primary malignant neoplasm is the occurrence of a second primary malignancy in the same patient within 6 months of the detection of first primary (synchronous), or 6 months or more after primary detection (metachronous). Multiple primary malignant neoplasms are not very frequently encountered in clinical practice. The relative risk for a second primary malignancy increases by 1.111-fold every month from the detection of the first primary malignancy in any individual. We present 2 patients treated for carcinoma of the breast who developed a metachronous primary malignancy in the stomach to highlight the rare occurrence of multiple primary malignant neoplasms. These tumors were histologically dissimilar, with distinct immunohistochemical parameters. The importance lies in carefully identifying the second primary malignancies, not dismissing them as metastases, and treating them accordingly.

NCPF is common in South India. Transient ascites occurs due to decompensation of liver function after variceal bleeding and in long standing cases of NCPF. Our study used Tc-sulphur scan for diagnosing NCPF in patients where liver biopsy was contraindicated in view of severe thrombocytopenia; however, the diagnostic utility of Tc-sulphur nuclear scan to diagnose NCPF in patients with severe hypersplenism needs to be further evaluated in future studies.

Background: Intraepithelial lymphocytes (IELs) are seen in between the epithelial cells in small and large intestine with the functions of immune surveillance and activation.Increased IELs can be the sole histological finding in latent celiac disease (CD). Aims:To study the utility and clinical relevance of IELs in diagnosing non-neoplastic lesions of duodenum and to determine a cut off for IEL to differentiate CD from other conditions. Materials & Methods:This was a prospective descriptive study.Duodenal biopsies from 101 patients with symptoms of malabsorption were studied. Informed written consent was taken. Clinical details were collected. Histomorphological parameters were studied on hematoxylin and eosin stained sections. Intraepithelial lymphocyte counts were done on CD3, CD4 and CD8 IHC stained sections. Statistical analysis was done using IBM-SPSS software version 21.P value <0.05 was considered statistically significant. The threshold score of IELs with maximum sensitivity and specificity was validated using the Receiver operator characteristic curve to distinguish CD from non-celiac disease conditions. Results:We studied 101 duodenal biopsies. Our spectrum included 16 patients of CD (15.8%), 15 of autoimmune duodenitis (14%), 13 of nutritional deficiency associated duodenitis (12.8%), 5 of infectious duodenitis (5%) and 41 patients of non-specific duodenitis (40.6%). The threshold levels were 5/20 villous tip IELs, 24 IELs/100 enterocytes on H& E and >31 IELs by CD3 IHC staining. Conclusion:Our study proposes IEL counts of >31/100 enterocytes in CD3 IHC staining to be significant in South Indian population to differentiate CD from other conditions.

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