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Spinal neurenteric cysts are very rare congenital anomalies and are commonly associated with other spinal malformations. They are usually located in intradural, extramedullary location. We report a rare case of intramedullary conus medullaris neurenteric cyst without any associated spinal malformation diagnosed preoperatively by magnetic resonance imaging.

Adult intussusception generally has a distinct pathological cause as a lead point. Inflammatory fibroid polyp (IFP) is a rare non-neoplastic submucosal lesion, furthermore, that polyp causing ileocolic intussusception in an adult is even rarer. Here we present a case of a 32-year-old female who presented with complaints of intermittent colicky pain associated with vomiting for 3 days. Computer tomography (CT) showed bowel obstruction caused by an ileocolic intussusception. Laparotomy with ileo-transverse anastomosis was done. Histopathological and immunohistochemistry (IHC) revealed that the cause of the intussusception was a rare inflammatory fibroid polyp. A benign condition being the cause of intussusception in an adult and the clinical symptoms were nonspecific posing clinical challenges makes this interesting case worthy of reporting.

We aimed to assess the incidence of the BRAF V600E mutation in thyroid neoplasms at a tertiary care center and its association with various phenotypic features. Methods and materialWe included all cases diagnosed as thyroid neoplasm in the past decade at the Department of Pathology of our institute and obtained their clinical details from the medical records department of the institute after obtaining permission from the authorities and due International Human Epigenome Consortium clearance. We included data on age, sex, clinical presentation, hormone status, and T and N status of the malignant neoplasms. Hematoxylin and eosin (H&E) slides of all cases were evaluated for the type of neoplasm, nuclear features, invasion into the capsule and vascular spaces, extrathyroidal extension, lymph node metastases, mitoses, necrosis, and presence/absence of amyloid. Paraffin blocks of sections with high tumor density and less normal tissue were chosen for evaluation after H&E staining. The slides showing tumors with large areas of hemorrhage, cystic change, or necrosis were excluded. Two primers were used to amplify a 339-bp fragment containing the V600E mutation in exon 15 of BRAF. Tissues were prepared from formalinfixed paraffin-embedded (FFPE) blocks, and DNA was isolated using a standard protocol BRAF NF and BRAF NR Primer Standardized Protocol For FFPE Tissue DNA. Percentages and tables have been used for data presentation. ResultsAmong 47 identified cases, 14 were positive for the BRAF V600E mutation and had papillary carcinoma (n = 9) or follicular neoplasms (n = 5; follicular adenoma, n = 3; follicular carcinoma, n = 2). In the BRAF-positive papillary carcinomas, five cases were aged 20-30 years, eight were female, eight (88.88%) were euthyroid, and one was hypothyroid. Furthermore, 55.55% (5/9 cases) of BRAF-positive cases were stage I, 33.3% (3/9 cases) were stage II, and 0.02% (1/9 cases) were stage III. ConclusionsIn our cohort, 31% of cases of papillary thyroid carcinoma (PTC) and 18.72% of follicular neoplasms expressed the BRAF V600E mutation. BRAF V600E mutation-positive papillary thyroid carcinomas consistently showed all characteristic nuclear features, such as nuclear crowding, overlapping, and grooves.Considering the greater prevalence in the younger age group, the importance of mutation surveillance in PTCs for a total thyroidectomy may be warranted in mutation-positive patients.

Eosinophil levels of blood utilized to assess occupational allergic responses among motor company workers in Chennai. Allergy is hypersensitivity disorder of immune system in response to allergic substances called allergens. Common allergens include pollen, pesticides, food, insects, dust, or mould. Eosinophila can also be seen in conditions like acute myeloid leukemia, Churg Strauss syndrome, in response to drugs, parasites. Aim and Objective: To study the prevalence of eosinophilia present in blood samples in a group of workers from a motor company without any clinical complaints who came for master health check-up at Saveetha Medical College and Hospital and to also study other parameters: age, sex, smoking habits, atopy. Materials and Methods: 290 haematology reports were taken from motor company workers who came for master health check-up at Saveetha Medical College Hospital. Samples were analysed by automated haematology analyser. Results: 290 haematology reports were analysed. Among these, 21% (62 patients) having eosinophilia wherein 88% having mild eosinophilia, 12% having moderate eosinophilia, none of the samples show severe eosinophilia. None of them having significant clinical symptom. Conclusion: Eosinophilia was seen in patients without any clinical symptoms. Mild to moderate eosinophilia was observed. There were no cases of severe eosinophilia. There was no significant relationship, suggesting that the nature of job undertaken by these motor company employees has nothing to do with eosinophilia in blood.

Rationale: IgG4-related disease (IgG4 RD) is a fibro-inflammatory condition that can affect any organ and can lead to the formation of pseudo tumoral lesions requiring differential diagnosis with various malignancies. IgG4 RD can rarely present as an intracranial space occupying lesion. We are reporting a rare case of central nervous system IgG4 RD which presented as seizures with mass lesion. Patient Concerns: A 78-year-old man with bronchial asthma and type 2 diabetes mellitus, well controlled on bronchodilators and oral hypoglycemic agents presented with recurring seizures for 1 month. He gave history of a fall and had sustained a wound over the right forehead. At presentation, he was conscious, oriented, and didn’t have any focal neurological deficits. Diagnosis: Due to the recurring seizures and fall, a contrast enhanced MRI brain was done and was reported as a right temporal space occupying lesion in the lateral sphenoid wing. Meningioma was considered as a possibility and right frontotemporal parietal craniotomy and excision was performed. However, biopsies revealed characteristic findings of IgG4-related disease, including 1) dense lymphoplasmacytic infiltration, 2) fibrosis arranged at least focally in a storiform pattern, and 3) obliterative phlebitis, which confirmed the diagnosis. His IgG4 levels were normal 0.58 g/L [normal range: 0.03 – 2.01 g/L]. Intervention: Patient underwent right frontotemporal parietal craniotomy and excision of mass under general anesthesia. Histopathology was suggestive of IgG4 RD and the patient was started on immunosuppressive therapy including dexamethasone and mycophenolate mofetil. Antiepileptic medications were continued, and he responded to treatment.

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