BACKGROUND: Precursor T-lymphoblastic lymphoma (T-LBL) is a rare lymphoma presenting clinically in children and adolescents with a rapidly enlarging mediastinal mass, dyspnea, and cervical lymphadenopathy requiring quick diagnosis.The objective of the current study was to report on the spectrum of cytomorphology and flow cytometric immunopheno-

Early and accurate detection of bone tumors and their staging are important since some of them are highly malignant. Intraoperative pathological consultation in bone tumors and tumor-like conditions is quite complex; however, it allows improvement in prognosis and limb salvage. Present study was conducted on 52 patients who underwent surgical procedure after clinical and radiological diagnosis of bone tumors/tumor-like conditions. Fresh unfixed tissue was quickly inspected grossly, followed by preparation of imprint smears and frozen section which were evaluated by two pathologists separately and compared subsequently with reports of paraffin-embedded sections. Clinical reasons for intraoperative consultation were to make diagnosis in 65.4% of cases and to determine resection margin status in 21.1% while in 13.5% of cases, it was for both indications. Diagnostic yield of imprint smears was 87.8% (13 malignant, 22 benign, and 1 tumor-like) and of frozen section was 90.2% (16 malignant, 19 benign, and 2 nonneoplastic) while paraffin sections could diagnose specific tumors in 95.1% (18 malignant, 18 benign, and 3 nonneoplastic). Although frozen section had better sensitivity (88.2%), it had less specificity (94.7%) as compared to imprint smears (76.5% and 100%, resp.). Imprint cytology and frozen section together provide a quick, safe, and reliable intraoperative provisional tissue diagnosis in skeletal tumors and tumor-like conditions.

Introduction: Xanthomas are defined as benign lesions characterized by an accumulation of lipid-laden macrophages that develop in the cutis and subcutaneous tissue. Xanthomas are classified as eruptive, tuberous, tendinous, or planar depending on their location and clinical appearance. Co-existence of both tuberous and tendinous forms in an atypical large-sized pattern is a rarity and presented herewith. Case Presentation: A 48-year-old male patient presented with multiple large masses in his elbows, knees, Achilles tendons, feet, and hands. The largest swellings measured 12 cm × 10 cm in dimensions. The blood workup of the patient showed an elevated level of low-density lipoprotein cholesterol and was subsequently diagnosed with Type IIa familial hypercholesterolemia and multiple large co-existing tuberous and tendinous xanthomas which is a rare clinical presentation. Local surgical excision was performed to remove the symptomatic massive xanthomas from the elbows, knees, and feet. Histological analysis of the surgical specimens confirmed the clinical diagnosis of xanthomas. Conclusion: Tuberous and tendinous xanthomas can co-exist in the same patient, including atypical large-sized forms. Usually, patients with xanthomas have some underlying metabolic lipid derangement and a cardiology workup to detect future cardiac risk is warranted. Intervention at an early stage can prevent the formation of disfiguring xanthomas in patients with underlying lipid disorder. The case also highlights a multi-disciplinary approach to such rare clinical presentations. Keywords: Xanthomas, Familial Hypercholesterolemia, Giant, Tuberous.

Background:Arachnoid proliferation, although rare, is known to occur in association with optic gliomas. However, chondroid and chordoid metaplasia has not been reported previously.Case Description:A 27-year-old male presented with progressive, painless loss of vision in right eye, associated with vomiting and headache for one and a half months. Computed tomography (CT) scan revealed a contrast enhancing mass arising from planum sphenoidale. Perioperative findings showed the tumor adherent to the right optic nerve and attached to basal dura and falx. A clinical impression of an intradural, optic nerve sheath meningioma was made. Histopathological examination revealed a glial tumor with adjacent areas displaying marked fibroblastic and arachnoid cell proliferation with chondroid as well as chordoid differentiation along with myxoid change and dense collagenisation. Reticulin stain, immunochemistry with glial fibrillary acid protein (GFAP), epithelial membrane antigen (EMA), and S-100 helped to arrive at the final diagnosis of optic glioma displaying exuberant arachnoid proliferation with cartilaginous metaplasia.Conclusion:We report a case of optic nerve glioma displaying extensive arachnoid proliferation, chordoid, and cartilaginous metaplasia, which mimicked chondrosarcoma or chordoid meningioma, posing a diagnostic dilemma. A clinical feedback, simple reticulin stain, and GFAP staining is of immense value in such cases to arrive at the correct diagnosis.

Introduction-Osteoid Osteomas are rare and extremely painful benign bone tumours. They are usually seen in children in the growing age group and young adults. The patients typically complain of bony pain during the night time and usually relieved with rest and salicylates. Osteoid Osteomas are commonly encountered in the limbs with Proximal femur/ Hip region and Tibial diaphysis being the usual locations.Pelvic locations are rare for osteoid osteoma and few cases have been published/ reported in literature.Case Presentation -A young female with long standing hip pain was diagnosed to have osteoid osteoma in an extremely rare location in her pelvic bone. After careful evaluation of the imaging the lesion was found to be in the Quadrilateral plate/Medial wall of acetabulum. After through pre-surgical planning she underwent the Gold-standard treatment for osteoid osteoma i.e., Computed Tomography (CT)-guided Radiofrequency Ablation (RFA). Immediate post-procedure the patient reported complete relief of her symptoms and has been symptoms-free for the past 2years of follow-up.Conclusion -A high level of clinical suspicion is warranted to keep osteoid osteoma as a differential diagnosis in a patient presenting with the relevant symptoms. They can be easily missed on Radiographs and CT is a clincher for diagnosis and unusual anatomic sites can harbour the same. A carefully planned Radiofrequency ablation under CT-guidance gives favourable and reliable results for treatment of osteoid osteomas.

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Introduction– Osteoid Osteomas are rare and extremely painful benign bone tumours. They are usually seen in children in the growing age group and young adults. The patients typically complain of bony pain during the night time and usually relieved with rest and salicylates. Osteoid Osteomas are commonly encountered in the limbs with Proximal femur/ Hip region and Tibial diaphysis being the usual locations. Pelvic locations are rare for osteoid osteoma and few cases have been published/ reported in literature. Case Presentation – A young female with long standing hip pain was diagnosed to have osteoid osteoma in an extremely rare location in her pelvic bone. After careful evaluation of the imaging the lesion was found to be in the Quadrilateral plate/Medial wall of acetabulum. After through pre-surgical planning she underwent the Gold-standard treatment for osteoid osteoma i.e., Computed Tomography (CT)- guided Radiofrequency Ablation (RFA). Immediate post-procedure the patient reported complete relief of her symptoms and has been symptoms-free for the past 2years of follow-up. Conclusion - A high level of clinical suspicion is warranted to keep osteoid osteoma as a differential diagnosis in a patient presenting with the relevant symptoms. They can be easily missed on Radiographs and CT is a clincher for diagnosis and unusual anatomic sites can harbour the same. A carefully planned Radiofrequency ablation under CT-guidance gives favourable and reliable results for treatment of osteoid osteomas.