Secretory carcinoma of the breast is an extremely rare subtype of breast cancer characterized by intracellular or extracellular secretion and granular eosinophilic cytoplasm of the neoplastic cells. The disease which was considered to be predominant in younger age group has been recognized in adult population too and tends to show slow growth and indolent behavior. The disease occurs preferentially in females and only 27 cases have been reported amongst males. An optimal treatment for the disease subtype has been debated because of the paucity of data. We report two cases (one female and one male) of this rare disease that underwent treatment at our institution.

Telementoring as a subset of telemedicine has evolved over the past few years, but it is yet to be utilized to its full potential. The technology holds promise in bridging divides of distance and enables far-flung areas to be mentored in operative advances. It thus has a special bearing in countries like India where health care is short staffed and many areas lack availability of quality care. We describe the setting up of a telementoring facility at our centre. As against a 'routine' facility with dedicated equipments which cost heavily, our facility was set up using mostly equipments commonly available in an operating room. The facility is presently functional and allows telementoring through an encrypted Web-based service. Our set-up design can be emulated in centres with financial constraint and can help raise the standard of surgical care.

HighlightsIatrogenic pneumothorax should be anticipated during and after a CT guided transthoracic needle biopsy and actively treated.Chest tube malposition is a common complication of tube thoracostomy.Chest tubes should always be inserted in the triangle of safety described by the British thoracic society.Debilitating subcutaneous emphysema which causes distress, anxiety, palpebral closure, dyspnoea or dysphagia requires intervention.High negative pressure subcutaneous suction drains provide immediate and sustained relief in extensive and debilitating SE.

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The association between hepatitis C virus (HCV) and sarcoidosis is well-documented, but in this case report, we shall discuss an interesting association between hepatitis B virus (HBV) and sarcoidosis, presenting with non-specific symptoms and confirmed with liver biopsy and immunologic markers. The case was complicated by treatment with immunosuppressive medication that led to colonic histoplasmosis. A 58-year-old woman, from the western part of India, who has a past medical history of HBVrelated cirrhosis of the liver for six months, hypertension, and type 2 diabetes presented to our clinic with bilateral pedal edema, anorexia, and mild epigastric discomfort. She had been on entecavir for the last six months. The patient denied any significant surgical, social, or family history. Abdominal ultrasonography revealed hepatosplenomegaly and mesenteric lymphadenopathy. She had a 21.3kPa liver stiffness on elastography and an HBV deoxyribonucleic acid (DNA) level of 89 copies/ml. Liver biopsy showed multiple noncaseating granulomas consisting of Langerhans cells in the parenchyma and portal tract, associated with moderate inflammation. A chest computed tomography (CT) scan showed upper and middle lobe fibrosis of the lungs; this diagnosis was further confirmed with elevated angiotensinconverting enzymes. She was started on prednisone; within a period of three months, she experienced weight loss, diarrhea, and fever. Colonoscopy was done after an abdomen CT showed mural thickening of the ascending colon and terminal ileum, which on biopsy was confirmed as histoplasmosis. Prednisone was stopped, and the patient was treated with hydroxychloroquine and amphotericin B, followed by itraconazole. The patient improved symptomatically, and repeated colonoscopy findings were normal. Studies are scarce to prove the association between hepatitis B and sarcoidosis; however, we reasonably hypothesized that the alterations in the pool of cytokines and immune cells caused by HBV infection might have had a vicious influence on immune regulation and could be a trigger for granuloma. Further studies can impact the future to provide for a better understanding of the pathophysiology of sarcoidosis, HBV correlation, and treatment options.

The solitary variant of rapidly growing large breast masses consisting of both epithelial and stromal components with no nodal involvement is called a phyllodes tumor and they are rare neoplasms of the breast. They constitute about 1% of all breast masses, with a slightly higher incidence in the Asian population. Although 10-30% of phyllodes tumors eventually undergo malignant transformation, which can either be in the epithelium or the stroma. However, heterologous transformation of phyllodes is an extremely rare entity. Here, we reported the case of a 60-year-old woman with an expeditiously growing breast mass for six months, which on biopsy raised a suspicion of malignant mesenchymal neoplasm. The patient underwent mastectomy with axillary sentinel lymph node biopsy (SLNB) and the final histopathological and immunohistochemistry examination revealed a phylloides tumor with a pleomorphic variety of liposarcomatous differentiation. Even with a typical mammographic appearance, liposarcomatous differentiation in phyllodes tumors can present a diagnostic dilemma on histopathology. Axillary sentinel lymph node biopsy (SLNB) forms a middle path in such cases of diagnostic challenge, which not only avoids the unnecessary morbidity of axillary lymph node dissection but also, at the same time, addresses the axilla in case the final histopathology shows evidence of invasive carcinoma.

Background: Gynecologic cancers form a huge burden of morbidity and mortality around the world. This study was undertaken to study the pattern, histopathological types and relative frequencies of gynaecological malignancy cases reported at four major hospitals and pathology centers in Jaipur region. Method: Retrospective review of records of gynecologic cancers obtained from four major pathology departments in Jaipur region in which histopathological data of all female diagnosed with the genital tract malignancies for a ve year period were included in the study. Results: Most common genital tract malignancy was cervical cancer (51.8%) followed by ovarian cancer (24.6%), uterine cancer (17.6%) and vaginal cancer (3.96%). Mean ages for ovarian, uterine, endometrium, fallopian tube, vulva and cervical cancers were 42.79±15.84, 50.93±13.14, 61.21±7.61, 63.50±19.09, 56.05±17.89 and 51.29±11.95 years respectively. Conclusion & Recommendations: Cervix carcinoma is the most common female genital tract malignancy followed by ovarian carcinoma and uterine cancer. Squamous type of cervical cancer was the commonest type. Hospital facilities for screening and regular gynecological examinations and well-dened follow-up surveillance system can change disease morbidity and mortality.