Shaji Thomas - Academia.edu (original) (raw)

Papers by Shaji Thomas

Research paper thumbnail of Randomized double blind trial comparing topical nitroglycerin with xylocaine and Proctosedyl in idiopathic chronic anal fisure

To compare symptomatic relief, healing, and changes in maximal anal resting pressure with the use... more To compare symptomatic relief, healing, and changes in maximal anal resting pressure with the use of topical formulations in patients with chronic anal fissure. Sixty-four consecutive patients with chronic anal fissure were randomized into 4 groups that received, in a double-blind manner, a topical ointment that contained 0.2% nitroglycerine (GTN), 5% xylocaine, Proctosedyl (hydrocortisone acetate, heparin, framycetin sulfate, esculoside, ethoform, butoform) or petroleum jelly (Vaseline), to be applied twice daily. Patients were reviewed at 2-week intervals for 6 weeks. Anal manometry was done before, and 20 minutes after, the first application of the ointment. There was significant (p < 0.0001) reduction in mean anal resting pressure after application of GTN, but not any other ointment. Of 16 patients receiving GTN, complete pain relief occurred in 6 and 15 patients after 2 and 4 weeks of treatment, respectively; this was more frequent than in the other 3 groups. At 6 weeks also, complete pain relief occurred more often with GTN than with Vaseline or xylocaine. After 4 weeks of treatment, 3 patients on GTN had complete healing of fissure as compared to one each in the xylocaine and Proctosedyl groups and none in the Vaseline group. At 6 weeks, healing of fissure had occurred in 15 of 16 patients receiving GTN as compared to 4 receiving Vaseline, 11 receiving xylocaine, and 12 on Proctosedyl. Topical nitroglycerine produces 'chemical sphincterotomy' with reduction in mean anal resting pressure. Pain relief and healing of fissure occurred earlier with GTN than with other treatments. GTN should be considered as the treatment of choice for the non-surgical management of patients with chronic anal fissure.

Research paper thumbnail of Denovo malignant fibrous histiocytoma of breast: report of a case and review of literature

Breast disease, 2014

Sarcomas are rare histological types of malignancy found in the breast. While angiosarcoma is the... more Sarcomas are rare histological types of malignancy found in the breast. While angiosarcoma is the most common type of sarcoma found here, malignant fibrous histiocytoma (MFH) arising de novo is one of the rare varieties. We recently cared for a middle aged lady with a locally advanced fungating growth in her right breast. The patient underwent right modified radical mastectomy (MRM) as her fine needle aspiration cytology report was suggestive of malignancy. The histopathological report revealed the tumour to be MFH. The patient had an uneventful postoperative recovery and is subjected to adjuvant radiotherapy.

Research paper thumbnail of Squamous cell carcinoma arising in epidermal inclusion cyst of breast: a diagnostic dilemma

Breast disease, 2015

Epidermal, or inclusion, cysts are frequently seen benign lesions that are lined with stratified ... more Epidermal, or inclusion, cysts are frequently seen benign lesions that are lined with stratified squamous epithelium. Malignant transformation of these is rare, occurring in 0.011% to 0.045% cases [1]. We herein report an unusual case of squamous cell carcinoma occurring in an epidermal cyst of the breast in a middle aged lady.

Research paper thumbnail of Immunohistochemical detection of axillary lymph node micrometastases in node negative breast cancer patients using cytokeratin and epithelial membrane antigen

South Asian Journal of Cancer, 2015

The study was conducted to detect occult metastases in lymph node negative breast cancer patients... more The study was conducted to detect occult metastases in lymph node negative breast cancer patients using cytokeratin (CK) and epithelial membrane antigen (EMA) immunohistochemistry (IHC) and correlate this with primary tumor size and grade. A total of 32 cases including 12 prospective and 20 retrospective cases of axillary lymph node negative breast cancer were studied. CK and EMA IHC were performed to detect micrometastases. Axillary lymph node metastases were detected in 18.75% of previously node negative cases using CK and EMA IHC. CK was found to be more sensitive for detection of metastases compared to EMA. A highly significant correlation was observed between tumor grade and axillary lymph node metastases detected by CK and EMA. However, no significant correlation was found between tumor size and axillary lymph node metastases detected by IHC. In the present study, there was an increase of 18.75% in the occult metastases detection rate using CK and EMA. To conclude, IHC detection of occult metastases should be done using CK in all axillary node negative cases, especially in T1 and T2 stage tumors.

Research paper thumbnail of Stromal Expression of CD10 in Invasive Breast Carcinoma and Its Correlation with ER, PR, HER2-neu, and Ki67

International Journal of Breast Cancer, 2011

CD10 is a cell surface zinc-dependent endopeptidase, which degrades many bioactive peptides. CD10... more CD10 is a cell surface zinc-dependent endopeptidase, which degrades many bioactive peptides. CD10 expression in tumour stroma is associated with biological aggressiveness of many epithelial malignancies. To date, only one study has correlated with expression of CD10 with well-known prognostic markers of breast, that is, ER, PR, Her2-neu, and tumour grade; however, its correlation with ki67 is still not studied. The aim of this study is to evaluate stromal CD10 expression in breast carcinoma and to examine its correlation with ER, PR, Her2-neu, and Ki67. Methods and Results. CD10 expression in fifty patients was assessed by immunohistochemistry and scored as negative, weak and strong. CD10 was found to be positive in stroma of 40/50 (80%) cases. Stromal CD10 showed positive correlation with tumour grade, Her2-neu (P = .000), and ki67 (P = .027), negative correlation with ER and PR. Conclusions. Hence CD10 expression correlated strongly with well-established negative prognostic markers, that is, Her2-neu and ki67 positivity, ER /PR negativity, and higher tumour grade, thus indicating that CD10 can be used as independent marker indicating poor prognosis and can be used as target for the development of novel therapies.

Research paper thumbnail of Retrorectal cystic hamartoma: A problematic ′Tail′

Journal of Surgical Technique and Case Report, 2014

The retrorectal space is an uncommon seat for neoplastic masses. Retrorectal hamartoma or tailgut... more The retrorectal space is an uncommon seat for neoplastic masses. Retrorectal hamartoma or tailgut cyst (TGC) is an uncommon developmental cystic lesion occurring in this space which mostly occurs in middle-aged females. We recently cared for a 16-year-old girl who presented with vague lower abdominal pain and occasional constipation. Per rectal examination revealed an extraluminal mass bulging from posterior rectal wall. Preoperative radiological investigations revealed by suggested it to be a mature cystic teratoma. The patient underwent exploratory laprotomy with en masse excision of the cyst. Histopathological examination of the specimen showed it to be a TGC. This case highlights the possibility of a TGC as a differential for retrorectal cystic lesions and the need to completely excise them given the possibility of future malignant transformation.

Research paper thumbnail of Giant Retroperitoneal Lymphangioma: a Rare Entity

Indian Journal of Surgery, 2013

Retroperitoneal lymphangiomas are rare benign tumors, and the exact incidence of which is not wel... more Retroperitoneal lymphangiomas are rare benign tumors, and the exact incidence of which is not well known. They usually arise from the developmental abnormalities of retroperitoneal lymphatics or their traumatic rupture. Confusion with other cystic tumors of the retroperitoneum including those arising from the kidney and pancreas is common. They usually lack specific symptoms and are mostly detected accidentally, while very rarely, some may present with complications such as rupture, torsion, hemorrhage, or infection. We report a case of a 22-year-old female in whom preoperative diagnosis of retroperitoneal lymphangioma was made on the basis of radiological investigations. On exploration, a large lymphangioma arising retroperitoneally was identified and excised. Postoperative recovery was uneventful.

Research paper thumbnail of Appendicular perforation in dengue fever: our experience

Asian Pacific Journal of Tropical Disease, 2014

Research paper thumbnail of Mixed medullary - papillary carcinoma thyroid: An uncommon variant of thyroid carcinoma

Journal of Laboratory Physicians, 2014

Mixed medullary-papillary carcinoma of the thyroid, a variant of medullary carcinoma is a rare th... more Mixed medullary-papillary carcinoma of the thyroid, a variant of medullary carcinoma is a rare thyroid malignancy accounting for less than 1% of the thyroid malignancies. We are presenting a case of 57-year-old lady with complaints of gradually increasing thyroid swelling for 1½ months. Fine-needle aspiration was suggestive of medullary carcinoma. Serum calcitonin levels were elevated. The patient underwent total thyoidectomy with regional cervical lymph node excision. Histopathologically, the diagnosis of mixed medullary-papillary carcinoma of the thyroid was made. It is important to know about this entity due to its prognostic implications and to prevent any diagnostic dilemmas.

Research paper thumbnail of Evaluation of Sentinel Node Biopsy in Locally Advanced Breast Cancer Patients Who Become Clinically Node-Negative after Neoadjuvant Chemotherapy: A Preliminary Study

International Journal of Breast Cancer, 2011

Introduction. Controversy continues over the appropriate timing of sentinel lymph node (SLN) biop... more Introduction. Controversy continues over the appropriate timing of sentinel lymph node (SLN) biopsy in locally advanced breast cancer (LABC) patients receiving neoadjuvant chemotherapy. We evaluated the feasibility and accuracy of SLN biopsy in LABC patients with cytology-proven axillary nodal metastasis who become clinically node-negative after neoadjuvant chemotherapy. Materials. 30 consecutive patients with LABC, who had become clinically node-negative after 3 cycles of neoadjuvant chemotherapy, were included in the study. They were then subjected to SLN biopsy, axillary lymph node dissection, and breast surgery. Results. Sentinel nodes were successfully identified in 26 of the 30 patients, resulting in an identification rate of 86.67%, sensitivity of 83.33%, false negative rate of 20%, negative predictive value of 72.73%, and an overall accuracy of 88.46%. No complications were observed as a result of dye injection. Conclusions. SLN biopsy is feasible and safe in LABC patients with cytology-positive nodes who become clinically node-negative after neoadjuvant chemotherapy. Our accuracy rate, identification rate, and false negative rate are comparable to those in node-negative LABC patients. SLN biopsy as a therapeutic option in LABC after neoadjuvant chemotherapy is a promising option which should be further investigated.

Research paper thumbnail of Synchronous papillary carcinoma in thyroglossal duct cyst and thyroid gland: Case report and review of literature

Head & Neck, 2009

Background. We report a rare case of synchronous occurrence of thyroglossal duct cyst carcinoma a... more Background. We report a rare case of synchronous occurrence of thyroglossal duct cyst carcinoma and thyroid carcinoma and discuss its management in detail.

Research paper thumbnail of Randomized Controlled Trial to Assess the Role of Raised Anal Pressures in the Pathogenesis of Symptomatic Early Hemorrhoids

Digestive Surgery, 2007

Increased maximum resting anal pressures (MRAP) have been found in patients with large prolapsed ... more Increased maximum resting anal pressures (MRAP) have been found in patients with large prolapsed hemorrhoids undergoing hemorrhoidectomy, but their pathogenic role is controversial especially in view of the sphincteric damage that occurs with open and stapled procedures. This prospective randomized clinical trial was conducted to compare anal pressure changes in early symptomatic hemorrhoidal disease before and after successful treatment with band ligation or injection sclerotherapy, and to compare these pressures with those in normal asymptomatic controls. 32 patients with symptomatic grade II hemorrhoids were randomized to treatment with either band ligation or injection sclerotherapy. Anal manometry was done before treatment and 8 weeks after completion of treatment, and compared with 20 normal age-matched controls. The pretreatment values in both study groups were similar to each other (69.38 cm H(2)O, 95% CI 58.67-80.08, vs. 67.75 cm H(2)O, 95% CI 56.86-78.64; p = 0.790), but were significantly higher (p = 0.0001 in both groups) than in the controls (45.25 cm H(2)O, 95% CI 38.36-52.14). After successful completion of treatment, there was a highly significant drop in the MRAP in both study groups (p = 0.0001 in group A, and p = 0.001 in group B) reaching normal values. Our study shows that even in early-stage hemorrhoids, the anal pressures are significantly raised, but after successful treatment with band ligation or injection sclerotherapy, these pressures return to normal, showing that they do not play a pathogenic role but are secondary to the congested hemorrhoidal cushions.

Research paper thumbnail of Topical nitroglycerin versus lateral internal sphincterotomy for chronic anal fissure: prospective, randomized trial

ANZ Journal of Surgery, 2005

Introduction: Topical nitroglycerin (GTN) is one of the medical treatments of choice in chronic a... more Introduction: Topical nitroglycerin (GTN) is one of the medical treatments of choice in chronic anal fissure. The present prospective, randomized, clinical trial was conducted to study the symptomatic relief, healing, and changes in the maximum anal resting pressure (MARP) in patients with chronic anal fissure comparing topical GTN and lateral sphincterotomy. Methods: Forty consecutive patients with chronic anal fissure were randomized for treatment with either topical GTN or internal sphincterotomy (20 patients in each group). Anal manometry was done before treatment in all patients, and 1 h after application of GTN or sphincterotomy. Patients were followed at 2-weekly intervals for 6 weeks for symptomatic relief and healing. Results: Both GTN and sphincterotomy brought about a highly significant, but comparable drop in the MARP after treatment ( P < 0.0001 in both groups). Sphincterotomy relieved pain much earlier compared to GTN (70% vs 40% at 2 weeks, P = 0.0032); but after 4 weeks of treatment, pain relief in both groups was comparable. Healing in the sphincterotomy group was also earlier than with GTN (55% vs 0% at 2 weeks, P < 0.0001; and 85% vs 30% at 4 weeks, P < 0.0001); but after 6 weeks, healing in both groups was comparable. Sphincterotomy had a significant incidence of minor, short-term complications; it also required surgical expertise, theatre time, and day-care beds. Nitroglycerin is safe, with mild and tolerable side-effects of headache and local burning sensation. Conclusion: Topical GTN should be the initial treatment in chronic anal fissure. Lateral sphincterotomy should be reserved for patients with severe disabling pain (because pain relief is much faster), and for patients not responding to at least 4 weeks of GTN therapy.

Research paper thumbnail of Comparison of the effect of diclofenac with hyoscine-N-butylbromide in the symptomatic treatment of acute biliary colic

ANZ Journal of Surgery, 2004

Background: Although non-steroidal anti-inflammatory drugs (NSAID) and spasmolytics have been use... more Background: Although non-steroidal anti-inflammatory drugs (NSAID) and spasmolytics have been used to relieve biliary colic, the role of these drugs in the natural history of biliary colic has not been clarified. The objective of the present study is to compare the efficacy of intramuscular diclofenac with intramuscular hyoscine in the treatment of pain of acute biliary colic, and to study their role in the natural history of biliary colic and in the prevention of cholelithiasis-related complications. Methods: Seventy-two consecutive patients with biliary colic were enrolled in this prospective, randomized, double-blind study. They received either a single 75 mg intramuscular dose of diclofenac ( n = 36) or similarly administered 20 mg of hyoscine ( n = 36). Pain severity was recorded on a visual analogue scale 30 min, 1 h, 2 h and 4 h after injection of the drug. Patients were then followed closely for the next 72 h for persistence or relapse of pain, or development of acute cholecystitis, or drug related complications. Results: Diclofenac provided much more rapid relief of pain than hyoscine, as shown by significantly lesser pain scores after injection of the drug. 91.7% of patients on diclofenac were completely relieved of pain at 4 h as compared to 69.4% with hyoscine ( P = 0.037). Progression to acute cholecystitis was seen in only 16.66% of patients on diclofenac as compared to 52.77% on hyoscine ( P = 0.003). Conclusions: In patients with biliary colic, diclofenac gives much faster and more effective pain relief in a significantly larger number of patients as compared with hyoscine. Most remarkably, diclofenac can prevent progression of biliary colic to acute cholecystitis in a significant number of patients.

Research paper thumbnail of Prospective evaluation of solitary thyroid nodule on 18F-FDG PET/CT and high-resolution ultrasonography

Annals of Nuclear Medicine, 2010

Purpose The utility of 18F-FDG PET/CT in the assessment of thyroid nodules is unclear as there ar... more Purpose The utility of 18F-FDG PET/CT in the assessment of thyroid nodules is unclear as there are several conflicting reports on the usefulness of SUV as an indicator to distinguish benign from malignant thyroid lesions. This study incorporated an additional parameter, namely dual time point imaging, to determine the diagnostic accuracy of PET/CT imaging. The performance of 18F-FDG PET/CT was compared to that of high-resolution ultrasound which is routinely used for the evaluation of thyroid nodules. Methods Two hundred patients with incidentally detected solitary thyroid nodules were included in the study. Each patient underwent ultrasound and PET/CT evaluation within 7 days of each other, reported by an experienced

Research paper thumbnail of Subcutaneous emphysema of the penis and scrotum mimicking gas gangrene: a rare complication of ERCP

Gastrointest Endoscop, 2011

... 2010 Oct 21. [Epub ahead of print] Subcutaneous emphysema of the penis and scrotum mimicking ... more ... 2010 Oct 21. [Epub ahead of print] Subcutaneous emphysema of the penis and scrotum mimicking gas gangrene: a rare complication of ERCP. Borgharia S, Jindal V, Gautam V, Singh N, Thomas S, Solanki RS. PMID: 20970792 [PubMed - as supplied by publisher].

Research paper thumbnail of Prospective Randomized trial comparing laparoscopic transabdominal preperitoneal (TAPP) and laparoscopic totally extra peritoneal (TEP) approach for bilateral inguinal hernias

International Journal of Surgery, 2015

Bilateral inguinal hernias form a part of the complex spectrum of weakness in the region of the m... more Bilateral inguinal hernias form a part of the complex spectrum of weakness in the region of the myopectineal orifice. Laparoscopic surgery is one of the standard approaches for bilateral hernias. We describe the results of a randomized trial that was undertaken to compare and evaluate TAPP and TEP repair for bilateral inguinal hernias. Sixty patients were randomized into two groups. Group I (TAPP) and Group II (TEP) were compared in terms of procedure related variables, conversion, post-operative recovery and complications. Analysis was done using SPSS software version 17. Seventy-seven patients were assessed for fitness to include in the study. Seventeen patients had to be excluded due to either not meeting the inclusion criteria&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s or for not giving consent. The median age (52yrs) was comparable in both groups. In Group II (TEP) mean operating time was 120.89 ± 29.28 min compared to 108.16 ± 16.10 min in Group I (TAPP). Post-operative pain scores were less in Group I(TAPP) at all levels of recording (8 h-48 h), though most patients required injectable analgesic for 32 h in both groups (p-value 0.029). Subcutaneous emphysema was more commonly noted in the Group II (TEP) (p-value 0.038). In Group I (TAPP) mean hospital stay was 52.0 ± 14.21 h while in Group II (TEP) it was 52.29 ± 9.36 h (p-value 0.427). Mean time for return to work was 11.8 ± 2.35 days in Group I (TAPP) and 12.41 ± 2.22 days in Group II (TEP) (p-value 0.339). The procedures though different in approach were quite similar in outcome. Mean operating time was increased in the TEP repairs along with immediate post-operative pain scores. The pattern of some complications like subcutaneous emphysema was significantly more in the TEP group while minor vascular injury though not significant was different in both groups. The indirect cost incurred from consumables did not vary other than need for more tacks in the TAPP group.

Research paper thumbnail of Epithelial myoepitheial carcinoma of minor salivary gland--low grade malignant tumor presenting with nodal metastasis

Indian journal of pathology & microbiology, 2006

Epithelial myoepithelial carcinoma (EMC) is a rare low grade malignant salivary gland neoplasm th... more Epithelial myoepithelial carcinoma (EMC) is a rare low grade malignant salivary gland neoplasm that most commonly occurs in the parotid gland but can also arise in minor salivary glands. We report a case of primary epithelial myoepithelial carcinoma of minor salivary gland in a 25 year old women who presented with swelling left cheek of one year duration and bilateral submandibular lymphadenopathy. A mass causing erosion of mandible, thyroid cartilage and masseter muscle was identified on CT scan. This was excised and histological examination revealed a mixture of ductal structures consisting of inner dark cells and outer clear cells seen in solid sheets. Immunohistochemical analysis showed the clear cells to be weakly positive for S100 and smooth muscle actin (SMA) and ductal cells to be positive for cytokeratin (CK) and epithelial membrane antigen (EMA). The characteristic morphological and immunohistochemical features aided in the diagnosis of epithelial myoepithelial carcinoma.

Research paper thumbnail of Primary neuroendocrine carcinoma breast: our experience

Breast disease, 2014

This retrospective study was designed to present the clinical characteristics and histopathologic... more This retrospective study was designed to present the clinical characteristics and histopathological features of Primary neuroendocrine carcinoma (PNEC) of breast, and to evaluate the impact on outcome following its management on the line of more common primary adenocarcinoma of breast. Records of four patients diagnosed with PNEC of breast were retrospectively reviewed. Data were obtained from medical record from January 2008 to December 2012. Diagnosis of PNEC was confirmed by histopathological examination (HPE) and immunohistochemical (IHC) staining of tissue obtained from Trucut biopsy of the breast lump in all four patients. PNEC of breast was defined by the presence of more than 50% of invasive tumor cells with cytoplasmic immunoreaction for neuroendocrine (NE) markers synaptophysin, chromogranin or neuron specific enolase as per WHO classification. All patients were treated with Modified Radical Mastectomy (MRM), six cycle of Cyclophosphamide, Adriamycin and 5-Flurouracil (CAF...

Research paper thumbnail of Emphysematous Pyelonephritis—a Rare Surgical Emergency Presenting to the Physician: A Case Report and Literature Review

Indian Journal of Surgery, 2012

Emphysematous pyelonephritis is an acute necrotizing parenchymal and perirenal infection caused b... more Emphysematous pyelonephritis is an acute necrotizing parenchymal and perirenal infection caused by gas-forming uropathogens. It is a rare condition, usually occurring in diabetic patients. Mortality rates in medically managed patients are as high as 70-90 %. It should be suspected in diabetic patients with urinary tract infections and worsening of renal function. CT scan is diagnostic and is the method of choice for diagnosis and follow-up. Both physicians and surgeons should be aware of this rare condition which might present to the physician as fulminant urinary tract infection in an uncontrolled diabetic patient, but which might warrant urgent surgical intervention by way of an emergency nephrectomy. We report a 60-year-old diabetic woman who presented with urinary infection and sepsis. Initially she was managed conservatively, but had to be taken up for emergency nephrectomy in view of her worsening condition. We review the clinical presentation, radiological diagnosis with characteristic CT scan pictures, and the management of this rare condition.

Research paper thumbnail of Randomized double blind trial comparing topical nitroglycerin with xylocaine and Proctosedyl in idiopathic chronic anal fisure

To compare symptomatic relief, healing, and changes in maximal anal resting pressure with the use... more To compare symptomatic relief, healing, and changes in maximal anal resting pressure with the use of topical formulations in patients with chronic anal fissure. Sixty-four consecutive patients with chronic anal fissure were randomized into 4 groups that received, in a double-blind manner, a topical ointment that contained 0.2% nitroglycerine (GTN), 5% xylocaine, Proctosedyl (hydrocortisone acetate, heparin, framycetin sulfate, esculoside, ethoform, butoform) or petroleum jelly (Vaseline), to be applied twice daily. Patients were reviewed at 2-week intervals for 6 weeks. Anal manometry was done before, and 20 minutes after, the first application of the ointment. There was significant (p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001) reduction in mean anal resting pressure after application of GTN, but not any other ointment. Of 16 patients receiving GTN, complete pain relief occurred in 6 and 15 patients after 2 and 4 weeks of treatment, respectively; this was more frequent than in the other 3 groups. At 6 weeks also, complete pain relief occurred more often with GTN than with Vaseline or xylocaine. After 4 weeks of treatment, 3 patients on GTN had complete healing of fissure as compared to one each in the xylocaine and Proctosedyl groups and none in the Vaseline group. At 6 weeks, healing of fissure had occurred in 15 of 16 patients receiving GTN as compared to 4 receiving Vaseline, 11 receiving xylocaine, and 12 on Proctosedyl. Topical nitroglycerine produces &amp;amp;amp;amp;amp;amp;amp;amp;#39;chemical sphincterotomy&amp;amp;amp;amp;amp;amp;amp;amp;#39; with reduction in mean anal resting pressure. Pain relief and healing of fissure occurred earlier with GTN than with other treatments. GTN should be considered as the treatment of choice for the non-surgical management of patients with chronic anal fissure.

Research paper thumbnail of Denovo malignant fibrous histiocytoma of breast: report of a case and review of literature

Breast disease, 2014

Sarcomas are rare histological types of malignancy found in the breast. While angiosarcoma is the... more Sarcomas are rare histological types of malignancy found in the breast. While angiosarcoma is the most common type of sarcoma found here, malignant fibrous histiocytoma (MFH) arising de novo is one of the rare varieties. We recently cared for a middle aged lady with a locally advanced fungating growth in her right breast. The patient underwent right modified radical mastectomy (MRM) as her fine needle aspiration cytology report was suggestive of malignancy. The histopathological report revealed the tumour to be MFH. The patient had an uneventful postoperative recovery and is subjected to adjuvant radiotherapy.

Research paper thumbnail of Squamous cell carcinoma arising in epidermal inclusion cyst of breast: a diagnostic dilemma

Breast disease, 2015

Epidermal, or inclusion, cysts are frequently seen benign lesions that are lined with stratified ... more Epidermal, or inclusion, cysts are frequently seen benign lesions that are lined with stratified squamous epithelium. Malignant transformation of these is rare, occurring in 0.011% to 0.045% cases [1]. We herein report an unusual case of squamous cell carcinoma occurring in an epidermal cyst of the breast in a middle aged lady.

Research paper thumbnail of Immunohistochemical detection of axillary lymph node micrometastases in node negative breast cancer patients using cytokeratin and epithelial membrane antigen

South Asian Journal of Cancer, 2015

The study was conducted to detect occult metastases in lymph node negative breast cancer patients... more The study was conducted to detect occult metastases in lymph node negative breast cancer patients using cytokeratin (CK) and epithelial membrane antigen (EMA) immunohistochemistry (IHC) and correlate this with primary tumor size and grade. A total of 32 cases including 12 prospective and 20 retrospective cases of axillary lymph node negative breast cancer were studied. CK and EMA IHC were performed to detect micrometastases. Axillary lymph node metastases were detected in 18.75% of previously node negative cases using CK and EMA IHC. CK was found to be more sensitive for detection of metastases compared to EMA. A highly significant correlation was observed between tumor grade and axillary lymph node metastases detected by CK and EMA. However, no significant correlation was found between tumor size and axillary lymph node metastases detected by IHC. In the present study, there was an increase of 18.75% in the occult metastases detection rate using CK and EMA. To conclude, IHC detection of occult metastases should be done using CK in all axillary node negative cases, especially in T1 and T2 stage tumors.

Research paper thumbnail of Stromal Expression of CD10 in Invasive Breast Carcinoma and Its Correlation with ER, PR, HER2-neu, and Ki67

International Journal of Breast Cancer, 2011

CD10 is a cell surface zinc-dependent endopeptidase, which degrades many bioactive peptides. CD10... more CD10 is a cell surface zinc-dependent endopeptidase, which degrades many bioactive peptides. CD10 expression in tumour stroma is associated with biological aggressiveness of many epithelial malignancies. To date, only one study has correlated with expression of CD10 with well-known prognostic markers of breast, that is, ER, PR, Her2-neu, and tumour grade; however, its correlation with ki67 is still not studied. The aim of this study is to evaluate stromal CD10 expression in breast carcinoma and to examine its correlation with ER, PR, Her2-neu, and Ki67. Methods and Results. CD10 expression in fifty patients was assessed by immunohistochemistry and scored as negative, weak and strong. CD10 was found to be positive in stroma of 40/50 (80%) cases. Stromal CD10 showed positive correlation with tumour grade, Her2-neu (P = .000), and ki67 (P = .027), negative correlation with ER and PR. Conclusions. Hence CD10 expression correlated strongly with well-established negative prognostic markers, that is, Her2-neu and ki67 positivity, ER /PR negativity, and higher tumour grade, thus indicating that CD10 can be used as independent marker indicating poor prognosis and can be used as target for the development of novel therapies.

Research paper thumbnail of Retrorectal cystic hamartoma: A problematic ′Tail′

Journal of Surgical Technique and Case Report, 2014

The retrorectal space is an uncommon seat for neoplastic masses. Retrorectal hamartoma or tailgut... more The retrorectal space is an uncommon seat for neoplastic masses. Retrorectal hamartoma or tailgut cyst (TGC) is an uncommon developmental cystic lesion occurring in this space which mostly occurs in middle-aged females. We recently cared for a 16-year-old girl who presented with vague lower abdominal pain and occasional constipation. Per rectal examination revealed an extraluminal mass bulging from posterior rectal wall. Preoperative radiological investigations revealed by suggested it to be a mature cystic teratoma. The patient underwent exploratory laprotomy with en masse excision of the cyst. Histopathological examination of the specimen showed it to be a TGC. This case highlights the possibility of a TGC as a differential for retrorectal cystic lesions and the need to completely excise them given the possibility of future malignant transformation.

Research paper thumbnail of Giant Retroperitoneal Lymphangioma: a Rare Entity

Indian Journal of Surgery, 2013

Retroperitoneal lymphangiomas are rare benign tumors, and the exact incidence of which is not wel... more Retroperitoneal lymphangiomas are rare benign tumors, and the exact incidence of which is not well known. They usually arise from the developmental abnormalities of retroperitoneal lymphatics or their traumatic rupture. Confusion with other cystic tumors of the retroperitoneum including those arising from the kidney and pancreas is common. They usually lack specific symptoms and are mostly detected accidentally, while very rarely, some may present with complications such as rupture, torsion, hemorrhage, or infection. We report a case of a 22-year-old female in whom preoperative diagnosis of retroperitoneal lymphangioma was made on the basis of radiological investigations. On exploration, a large lymphangioma arising retroperitoneally was identified and excised. Postoperative recovery was uneventful.

Research paper thumbnail of Appendicular perforation in dengue fever: our experience

Asian Pacific Journal of Tropical Disease, 2014

Research paper thumbnail of Mixed medullary - papillary carcinoma thyroid: An uncommon variant of thyroid carcinoma

Journal of Laboratory Physicians, 2014

Mixed medullary-papillary carcinoma of the thyroid, a variant of medullary carcinoma is a rare th... more Mixed medullary-papillary carcinoma of the thyroid, a variant of medullary carcinoma is a rare thyroid malignancy accounting for less than 1% of the thyroid malignancies. We are presenting a case of 57-year-old lady with complaints of gradually increasing thyroid swelling for 1½ months. Fine-needle aspiration was suggestive of medullary carcinoma. Serum calcitonin levels were elevated. The patient underwent total thyoidectomy with regional cervical lymph node excision. Histopathologically, the diagnosis of mixed medullary-papillary carcinoma of the thyroid was made. It is important to know about this entity due to its prognostic implications and to prevent any diagnostic dilemmas.

Research paper thumbnail of Evaluation of Sentinel Node Biopsy in Locally Advanced Breast Cancer Patients Who Become Clinically Node-Negative after Neoadjuvant Chemotherapy: A Preliminary Study

International Journal of Breast Cancer, 2011

Introduction. Controversy continues over the appropriate timing of sentinel lymph node (SLN) biop... more Introduction. Controversy continues over the appropriate timing of sentinel lymph node (SLN) biopsy in locally advanced breast cancer (LABC) patients receiving neoadjuvant chemotherapy. We evaluated the feasibility and accuracy of SLN biopsy in LABC patients with cytology-proven axillary nodal metastasis who become clinically node-negative after neoadjuvant chemotherapy. Materials. 30 consecutive patients with LABC, who had become clinically node-negative after 3 cycles of neoadjuvant chemotherapy, were included in the study. They were then subjected to SLN biopsy, axillary lymph node dissection, and breast surgery. Results. Sentinel nodes were successfully identified in 26 of the 30 patients, resulting in an identification rate of 86.67%, sensitivity of 83.33%, false negative rate of 20%, negative predictive value of 72.73%, and an overall accuracy of 88.46%. No complications were observed as a result of dye injection. Conclusions. SLN biopsy is feasible and safe in LABC patients with cytology-positive nodes who become clinically node-negative after neoadjuvant chemotherapy. Our accuracy rate, identification rate, and false negative rate are comparable to those in node-negative LABC patients. SLN biopsy as a therapeutic option in LABC after neoadjuvant chemotherapy is a promising option which should be further investigated.

Research paper thumbnail of Synchronous papillary carcinoma in thyroglossal duct cyst and thyroid gland: Case report and review of literature

Head & Neck, 2009

Background. We report a rare case of synchronous occurrence of thyroglossal duct cyst carcinoma a... more Background. We report a rare case of synchronous occurrence of thyroglossal duct cyst carcinoma and thyroid carcinoma and discuss its management in detail.

Research paper thumbnail of Randomized Controlled Trial to Assess the Role of Raised Anal Pressures in the Pathogenesis of Symptomatic Early Hemorrhoids

Digestive Surgery, 2007

Increased maximum resting anal pressures (MRAP) have been found in patients with large prolapsed ... more Increased maximum resting anal pressures (MRAP) have been found in patients with large prolapsed hemorrhoids undergoing hemorrhoidectomy, but their pathogenic role is controversial especially in view of the sphincteric damage that occurs with open and stapled procedures. This prospective randomized clinical trial was conducted to compare anal pressure changes in early symptomatic hemorrhoidal disease before and after successful treatment with band ligation or injection sclerotherapy, and to compare these pressures with those in normal asymptomatic controls. 32 patients with symptomatic grade II hemorrhoids were randomized to treatment with either band ligation or injection sclerotherapy. Anal manometry was done before treatment and 8 weeks after completion of treatment, and compared with 20 normal age-matched controls. The pretreatment values in both study groups were similar to each other (69.38 cm H(2)O, 95% CI 58.67-80.08, vs. 67.75 cm H(2)O, 95% CI 56.86-78.64; p = 0.790), but were significantly higher (p = 0.0001 in both groups) than in the controls (45.25 cm H(2)O, 95% CI 38.36-52.14). After successful completion of treatment, there was a highly significant drop in the MRAP in both study groups (p = 0.0001 in group A, and p = 0.001 in group B) reaching normal values. Our study shows that even in early-stage hemorrhoids, the anal pressures are significantly raised, but after successful treatment with band ligation or injection sclerotherapy, these pressures return to normal, showing that they do not play a pathogenic role but are secondary to the congested hemorrhoidal cushions.

Research paper thumbnail of Topical nitroglycerin versus lateral internal sphincterotomy for chronic anal fissure: prospective, randomized trial

ANZ Journal of Surgery, 2005

Introduction: Topical nitroglycerin (GTN) is one of the medical treatments of choice in chronic a... more Introduction: Topical nitroglycerin (GTN) is one of the medical treatments of choice in chronic anal fissure. The present prospective, randomized, clinical trial was conducted to study the symptomatic relief, healing, and changes in the maximum anal resting pressure (MARP) in patients with chronic anal fissure comparing topical GTN and lateral sphincterotomy. Methods: Forty consecutive patients with chronic anal fissure were randomized for treatment with either topical GTN or internal sphincterotomy (20 patients in each group). Anal manometry was done before treatment in all patients, and 1 h after application of GTN or sphincterotomy. Patients were followed at 2-weekly intervals for 6 weeks for symptomatic relief and healing. Results: Both GTN and sphincterotomy brought about a highly significant, but comparable drop in the MARP after treatment ( P < 0.0001 in both groups). Sphincterotomy relieved pain much earlier compared to GTN (70% vs 40% at 2 weeks, P = 0.0032); but after 4 weeks of treatment, pain relief in both groups was comparable. Healing in the sphincterotomy group was also earlier than with GTN (55% vs 0% at 2 weeks, P < 0.0001; and 85% vs 30% at 4 weeks, P < 0.0001); but after 6 weeks, healing in both groups was comparable. Sphincterotomy had a significant incidence of minor, short-term complications; it also required surgical expertise, theatre time, and day-care beds. Nitroglycerin is safe, with mild and tolerable side-effects of headache and local burning sensation. Conclusion: Topical GTN should be the initial treatment in chronic anal fissure. Lateral sphincterotomy should be reserved for patients with severe disabling pain (because pain relief is much faster), and for patients not responding to at least 4 weeks of GTN therapy.

Research paper thumbnail of Comparison of the effect of diclofenac with hyoscine-N-butylbromide in the symptomatic treatment of acute biliary colic

ANZ Journal of Surgery, 2004

Background: Although non-steroidal anti-inflammatory drugs (NSAID) and spasmolytics have been use... more Background: Although non-steroidal anti-inflammatory drugs (NSAID) and spasmolytics have been used to relieve biliary colic, the role of these drugs in the natural history of biliary colic has not been clarified. The objective of the present study is to compare the efficacy of intramuscular diclofenac with intramuscular hyoscine in the treatment of pain of acute biliary colic, and to study their role in the natural history of biliary colic and in the prevention of cholelithiasis-related complications. Methods: Seventy-two consecutive patients with biliary colic were enrolled in this prospective, randomized, double-blind study. They received either a single 75 mg intramuscular dose of diclofenac ( n = 36) or similarly administered 20 mg of hyoscine ( n = 36). Pain severity was recorded on a visual analogue scale 30 min, 1 h, 2 h and 4 h after injection of the drug. Patients were then followed closely for the next 72 h for persistence or relapse of pain, or development of acute cholecystitis, or drug related complications. Results: Diclofenac provided much more rapid relief of pain than hyoscine, as shown by significantly lesser pain scores after injection of the drug. 91.7% of patients on diclofenac were completely relieved of pain at 4 h as compared to 69.4% with hyoscine ( P = 0.037). Progression to acute cholecystitis was seen in only 16.66% of patients on diclofenac as compared to 52.77% on hyoscine ( P = 0.003). Conclusions: In patients with biliary colic, diclofenac gives much faster and more effective pain relief in a significantly larger number of patients as compared with hyoscine. Most remarkably, diclofenac can prevent progression of biliary colic to acute cholecystitis in a significant number of patients.

Research paper thumbnail of Prospective evaluation of solitary thyroid nodule on 18F-FDG PET/CT and high-resolution ultrasonography

Annals of Nuclear Medicine, 2010

Purpose The utility of 18F-FDG PET/CT in the assessment of thyroid nodules is unclear as there ar... more Purpose The utility of 18F-FDG PET/CT in the assessment of thyroid nodules is unclear as there are several conflicting reports on the usefulness of SUV as an indicator to distinguish benign from malignant thyroid lesions. This study incorporated an additional parameter, namely dual time point imaging, to determine the diagnostic accuracy of PET/CT imaging. The performance of 18F-FDG PET/CT was compared to that of high-resolution ultrasound which is routinely used for the evaluation of thyroid nodules. Methods Two hundred patients with incidentally detected solitary thyroid nodules were included in the study. Each patient underwent ultrasound and PET/CT evaluation within 7 days of each other, reported by an experienced

Research paper thumbnail of Subcutaneous emphysema of the penis and scrotum mimicking gas gangrene: a rare complication of ERCP

Gastrointest Endoscop, 2011

... 2010 Oct 21. [Epub ahead of print] Subcutaneous emphysema of the penis and scrotum mimicking ... more ... 2010 Oct 21. [Epub ahead of print] Subcutaneous emphysema of the penis and scrotum mimicking gas gangrene: a rare complication of ERCP. Borgharia S, Jindal V, Gautam V, Singh N, Thomas S, Solanki RS. PMID: 20970792 [PubMed - as supplied by publisher].

Research paper thumbnail of Prospective Randomized trial comparing laparoscopic transabdominal preperitoneal (TAPP) and laparoscopic totally extra peritoneal (TEP) approach for bilateral inguinal hernias

International Journal of Surgery, 2015

Bilateral inguinal hernias form a part of the complex spectrum of weakness in the region of the m... more Bilateral inguinal hernias form a part of the complex spectrum of weakness in the region of the myopectineal orifice. Laparoscopic surgery is one of the standard approaches for bilateral hernias. We describe the results of a randomized trial that was undertaken to compare and evaluate TAPP and TEP repair for bilateral inguinal hernias. Sixty patients were randomized into two groups. Group I (TAPP) and Group II (TEP) were compared in terms of procedure related variables, conversion, post-operative recovery and complications. Analysis was done using SPSS software version 17. Seventy-seven patients were assessed for fitness to include in the study. Seventeen patients had to be excluded due to either not meeting the inclusion criteria&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s or for not giving consent. The median age (52yrs) was comparable in both groups. In Group II (TEP) mean operating time was 120.89 ± 29.28 min compared to 108.16 ± 16.10 min in Group I (TAPP). Post-operative pain scores were less in Group I(TAPP) at all levels of recording (8 h-48 h), though most patients required injectable analgesic for 32 h in both groups (p-value 0.029). Subcutaneous emphysema was more commonly noted in the Group II (TEP) (p-value 0.038). In Group I (TAPP) mean hospital stay was 52.0 ± 14.21 h while in Group II (TEP) it was 52.29 ± 9.36 h (p-value 0.427). Mean time for return to work was 11.8 ± 2.35 days in Group I (TAPP) and 12.41 ± 2.22 days in Group II (TEP) (p-value 0.339). The procedures though different in approach were quite similar in outcome. Mean operating time was increased in the TEP repairs along with immediate post-operative pain scores. The pattern of some complications like subcutaneous emphysema was significantly more in the TEP group while minor vascular injury though not significant was different in both groups. The indirect cost incurred from consumables did not vary other than need for more tacks in the TAPP group.

Research paper thumbnail of Epithelial myoepitheial carcinoma of minor salivary gland--low grade malignant tumor presenting with nodal metastasis

Indian journal of pathology & microbiology, 2006

Epithelial myoepithelial carcinoma (EMC) is a rare low grade malignant salivary gland neoplasm th... more Epithelial myoepithelial carcinoma (EMC) is a rare low grade malignant salivary gland neoplasm that most commonly occurs in the parotid gland but can also arise in minor salivary glands. We report a case of primary epithelial myoepithelial carcinoma of minor salivary gland in a 25 year old women who presented with swelling left cheek of one year duration and bilateral submandibular lymphadenopathy. A mass causing erosion of mandible, thyroid cartilage and masseter muscle was identified on CT scan. This was excised and histological examination revealed a mixture of ductal structures consisting of inner dark cells and outer clear cells seen in solid sheets. Immunohistochemical analysis showed the clear cells to be weakly positive for S100 and smooth muscle actin (SMA) and ductal cells to be positive for cytokeratin (CK) and epithelial membrane antigen (EMA). The characteristic morphological and immunohistochemical features aided in the diagnosis of epithelial myoepithelial carcinoma.

Research paper thumbnail of Primary neuroendocrine carcinoma breast: our experience

Breast disease, 2014

This retrospective study was designed to present the clinical characteristics and histopathologic... more This retrospective study was designed to present the clinical characteristics and histopathological features of Primary neuroendocrine carcinoma (PNEC) of breast, and to evaluate the impact on outcome following its management on the line of more common primary adenocarcinoma of breast. Records of four patients diagnosed with PNEC of breast were retrospectively reviewed. Data were obtained from medical record from January 2008 to December 2012. Diagnosis of PNEC was confirmed by histopathological examination (HPE) and immunohistochemical (IHC) staining of tissue obtained from Trucut biopsy of the breast lump in all four patients. PNEC of breast was defined by the presence of more than 50% of invasive tumor cells with cytoplasmic immunoreaction for neuroendocrine (NE) markers synaptophysin, chromogranin or neuron specific enolase as per WHO classification. All patients were treated with Modified Radical Mastectomy (MRM), six cycle of Cyclophosphamide, Adriamycin and 5-Flurouracil (CAF...

Research paper thumbnail of Emphysematous Pyelonephritis—a Rare Surgical Emergency Presenting to the Physician: A Case Report and Literature Review

Indian Journal of Surgery, 2012

Emphysematous pyelonephritis is an acute necrotizing parenchymal and perirenal infection caused b... more Emphysematous pyelonephritis is an acute necrotizing parenchymal and perirenal infection caused by gas-forming uropathogens. It is a rare condition, usually occurring in diabetic patients. Mortality rates in medically managed patients are as high as 70-90 %. It should be suspected in diabetic patients with urinary tract infections and worsening of renal function. CT scan is diagnostic and is the method of choice for diagnosis and follow-up. Both physicians and surgeons should be aware of this rare condition which might present to the physician as fulminant urinary tract infection in an uncontrolled diabetic patient, but which might warrant urgent surgical intervention by way of an emergency nephrectomy. We report a 60-year-old diabetic woman who presented with urinary infection and sepsis. Initially she was managed conservatively, but had to be taken up for emergency nephrectomy in view of her worsening condition. We review the clinical presentation, radiological diagnosis with characteristic CT scan pictures, and the management of this rare condition.