Abhimanyu Grover is a Resident of Patiala, Punjab, India. He has graduated from Government Medical College and Hospital, Amritsar. After completion of Internship, he was commissioned as a Medical Officer in the Indian Air Force at the rank of Flight Lieutenant in December 2009. He has served in the Indian Armed Forces for a period of eight years and four months and completed his tenure as a Short Service Commissioned Officer, in April 2018. Currently, he is pursuing his Post-graduation in Pathology, at Kalinga Institute of Medical Sciences and PBMH, Bhubaneswar, Odisha, India.

Background: Bullous systemic lupus erythematosus (BSLE) is a rare autoimmune disease characterized by generalized bullous eruption. It is a unique bullous disease phenotype characterized by with distinctive clinical features of tense bullae involving the sun-exposed areas and confirmed on histologically by subepidermal bullae with predominantly polymorphic infiltrate. Immunopathological features reveal immunoglobulin and complement deposition at dermoepidermal junction. Case report: Twenty seven (27) -year- old female presented with fever, myalgia, arthralgia, fatigue, vesiculobullous skin eruptions, oral ulcers since two months. The vesiculobullous lesions were primarily localized at the forehead, lower part of face and front of neck. Laboratory investigations revealed a positive ANA, raised anti-dsDNA titre, low serum C3 and C4 levels with anemia (Hb 6.1 g/dl). On histological examination subepidermal bullae with neutrophilic infiltration and karyorrhectic debris in the epidermal layers were seen. Direct IF revealed dermoepidermal deposition of IgG and C3. The patient was diagnosed as Bullous systemic lupus erythematosus (BSLE). She was treated with dapsone and was cured completely. Conclusion: BSLE is an uncommon condition. It requires good clinical acumen to differentiate it from similar conditions and prompt investigations for quick diagnosis as it responds very well to treatment.

Vigyan Mishra is currently pursuing his Post-graduate, MD Pathology at Kalinga Institute of Medical Science, KIIT University, Bhubaneswar, Odisha, India. After completing his MBBS from RD Gardi Medical College, Ujjain, Madhya Pradesh, India, and he served in under National Rural Health Mission at Anuppur district, Madhya Pradesh, India and developed interest in Pathology. Currently, he is working on his first scientific initiation and a two years prospective study on “Expression of Cyclin D1 and p53 in Oral Squamous Cell Carcinoma”.

Endometrial stromal sarcoma (ESS) is a rare neoplasm comprising 0.2% of all uterine malignancies. Though synchronous ESS and bilateral ovarian endometrioid adenocarcinoma is documented but to the best of our knowledge this is the first case of synchronous ESS and bilateral serous adenocarcinoma of ovary. A 48-year-old female presented with pain in lower abdomen and irregular bleeding per vaginum. Sonography revealed bulky uterus. Hysterectomy with bilateral salpingectomy was done. Gross: Large polypoid mass within endometrial cavity. Microscopy: Nests and islands of uniform, bland looking tumor cells permeating into the myometrium. Foci of adenomyos are also seen. Tumor cells were CD10 positive. A diagnosis of low grade ESS was made. Subsequent CT scan was unremarkable. Bilateral oophorectomy was done. Grossly both the ovaries appear normal. Microscopy: Small foci of tumor present beneath the surface of each ovary. Tumor cells were arranged in papillary, glandular and cribriform pattern with high grade nuclear morphology and good number of mitosis. Cells were CK7, CA125 and WT1 positive. Diagnosis: Low grade endometrial stromal sarcoma with synchronous bilateral serous adenocarcinoma of ovary. Endometriosis is a known risk factor for neoplasm. Possible association between these entities may be due to malignant transformation of adenomyosis and endometriosis.

I V Kastyro has completed his PhD from RUDN University and Post-doctoral studies from RUDN University. He has published more than 10 papers in reputed journals and has been serving as an Editorial Board Member of repute.

Background: Surgical interventions in the craniofacial area are a strong stress factor due to its particular sensitivity, especially in the nasal septum. In this regard, the issue remains high-quality anesthesia. Objective: The aim of the study is to identify the morphological changes in the hippocampus of the brain of rats when modeling septoplasty. Materials & Methods: The study was conducted on 80 adult males-rats. In the experimental one and two groups, premedication with Phenazepamum was carried out. Group 1: Thirty (30) rats, local infiltration anesthesia with 2% lidocaine solution; group 2: Thirty (30) rats, local infiltration anesthesia with 2% ultracaine solution, postoperative analgesia with diclofenac sodium solution for six days after surgery. Groups 3 and 4 were controls and included 10 animals each. In groups 1-3, pretrepantation fixation of the brain was performed; in group 4, similar fixation was not performed and artifact dark neurons were counted. We studied the number of dark neurons in the hippocampus on hematoxylin-eosin stained brain sections on days two, six and 14 after surgery. Results: In group two, in the CA1, CA2, CA3 and DG zones, there were fewer dark neurons (DN) compared with group one on day six (p<0.05), and on day 14 in group two, the number of dark neurons was comparable with group three in areas CA1 and CA2 (p<0.05). In group four, compared with group three, the number of DN was significantly higher in all hippocampal zones (p<0.05). Conclusion: The quantitative changes of DN in different zones of the hippocampus may indicate the severity of surgical stress with various anesthesiological benefits when carrying out simulation of septoplasty.

Nina Shved has graduated from First Pavlov State Medical University of St. Petersburg (Saint-Petersburg, Russia).

Basal cell carcinoma (BCC) is the most common malignant neoplasm of the skin, which has a low metastatic potential. The frequency of metastases of BCC ranges from 0.0028% to 0.55%, with the most frequent localization in regional lymph nodes, bones, lungs and liver. Our aim is to analysis of structural, molecular and genetic features of the metastatic BCC. For the study, two cases of metastatic BCC were selected from more than 3,563 cases of BCC that were observed in the period from 2012 to 2018 in the Moscow City Oncology Hospital No 62. Patients are male and female, 65 and 73 years old. In a man, the debut of the disease was registered in 2008, with primary localization on the skin of the anterior chest wall; in the same year, a total resection of the tumor site was performed. In the middle of 2018. metastases in the lumbar vertebra were detected (treatment is not initiated). The woman has a debut of the disease in 2003 on the plantar surface of the right foot. Only in 2009, laser destruction of the formation without histological verification was carried out. At the end of 2011 - relapse, followed by total resection of the tumor site and local radiation therapy. In 2014, metastases were found in regional lymphatic; extirpation of lymph nodes was performed. In 2017, new metastatic foci in both lungs and sigmoid colon were detected. The patient was prescribed therapy with SMO inhibitors. The therapy achieved stabilization of the tumor site in the sigmoid colon, and complete regression of metastatic nodes in the lungs. However, at the end of this year, a new metastasis in the skin of the anterior abdominal wall appeared.

Zorana Randelovic is pursuing her Medicine from University of Nis, the Faculty of Medicine, Serbia. She is a Member of The Association of Preventive Pediatrics of Serbia. She speaks three languages. As a Pathology lover, she decided to take part in Pathology Congress in order to acquire new knowledge in the field of Pathology.

Introduction: Metaplastic and malignant phyllodes tumors represent rather rare groups of breast tumors. Immunohistochemical analysis places them among hormone-independent tumors with negative HER2 expression. They are characterized by high mitotic activity, high Ki67 proliferative index and a high degree of polymorphism. They pose a serious challenge in the differential diagnosis, and very often a problem in work of the pathologist. The aim of this study is to differentiate these two tumor groups by applying immunohistochemistry and morphometry. Materials & Methods: Fifteen metaplastic carcinomas and 10 malignant phyllodes tumors were analyzed. Immunohistochemical and morphometric analyses were performed. Six nuclear parameters were monitored (area, perimeter, circularity, round, Feret diameter and integrated optical density), as well as the expression of CK-AE1/AE3, p53, vimentin, Ki67, CD117, p63, CD34, ER, PR, HER2 and S100 protein. Results: The morphometric analysis showed a statistically significant difference for the parameters for circularity (0.87±0.03; 0.82±0.07, for p<0.05) and roundness (0.71±0.06; 0.60±0.10, for p<0.05). Ki67 index was above 50% in both groups, but with no statistical significance. The expression of CD117 and CD34 was 100% in phyllodes, whereas it was negative in the metaplastic group. CK-AE1/AE3, S100 and p63 were expressed in metaplastic carcinomas, whereas vimentin and p53 were positive in both groups. Discussion: These two tumor groups may represent a serious diagnostical problem, especially when small samples are analyzed in incisional and core biopsies. In order to set a precise diagnosis, when it is not possible to analyze the whole tumor and its edges, it is necessary to apply immunohistochemical methods, as well as the morphometric analysis.