Solitary Extramedullary Plasmacytoma of Nasal Cavity

Solitary extramedullary plasmacytoma (SEP) of the nasal cavity is a rare neoplastic condition characterized by the localized proliferation of abnormal plasma cells. We present a case of SEP involving the nasal cavity in a 40-year-old male patient who presented with nasal obstruction and recurrent epistaxis. The diagnosis was confirmed through clinical evaluation, imaging studies, and histopathological examination of excised specimen. The patient underwent trans-nasal endoscopic excision of nasal mass without any adjuvant therapy, which resulted in successful local control. This case report highlights the clinical presentation, diagnostic approach, treatment modalities, and favourable prognosis associated with solitary extramedullary plasmacytoma of the nasal cavity.

Role of cytopathology in diagnosing phaeohyphomycosis masquerading as nerve abscess in a lepromatous leprosy patient: A case report

INTRODUCTION AND IMPORTANCE

Phaeohyphomycosis is a rare fungal infection primarily affecting immunocompromised individuals. Its clinical manifestations are diverse, and diagnosis can be challenging, particularly when lesions mimic other conditions.

CASE PRESENTATION

A 66-year-old male, with a history of irregular leprosy treatment and prolonged steroid use, presented with symptoms suggestive of a nerve abscess. On examination, cystic swellings were observed on the left thumb and leg. Histopathological examination and fine needle aspiration cytology (FNAC) revealed melanized hyphae, leading to a final diagnosis of phaeohyphomycosis. The patient was treated with oral itraconazole, leading to regression in lesion size.

CLINICAL DISCUSSION

Leprosy patients on long-term steroids are especially susceptible. The pathogenicity of these fungi in immunocompetent people is believed to be due to melanin in their cell walls, which defends against host defenses. Diagnosis involves histopathological examinations, staining, and fungal culture. Treatment involves surgical excision and antifungal drugs. If untreated, it can lead to severe complications including fatal brain infections.

CONCLUSION

This case highlights the unusual presentation of phaeohyphomycosis mimicking a nerve abscess in a leprosy patient. It underscores the importance of a high degree of clinical suspicion in diagnosing such rare infections, particularly in immunocompromised individuals. It also emphasizes the value of FNAC in reaching a definitive diagnosis. Prompt diagnosis and appropriate treatment are essential to prevent potentially serious outcomes.

Hypoplastic coronary artery disease, as a cause of sudden death

Hypoplastic coronary artery disease (HCAD) is a rare coronary artery anomaly that may be the cause of sudden death. It can involve a single or all coronary arteries. This anomaly may cause circulatory insufficiency leading to myocardial infarction. HCAD has no symptoms or may exhibit cardiovascular signs like syncope, dyspnea, chest discomfort, or dizziness. It is often diagnosed at autopsy, and early diagnosis is made with a coronary angiogram. We report HCAD as the cause of the sudden death of a 25-year-old female with a history of loss of consciousness following exertion. On autopsy, all the coronary arteries' lumen was narrowed with thin vessel walls. Histopathological examination shows an underdeveloped and missing muscular layer of the left anterior descending and circumflex coronary arteries' vascular wall. Many cases of HCAD diagnosed by radiographic imaging in living patients have been reported in the literature, but a structural anomaly of coronaries leading to HCAD has not been reported. We report a case of HCAD describing the histopathological examination findings of the vascular wall of coronary vessels illustrating the structural difference.

Tolosa Hunt Syndrome: A Challenging Diagnosis from Otorhinolaryngologist Perspective-A Case Report

Tolosa Hunt syndrome is a rare disorder characterized by idiopathic chronic granulomatous lesion involving cavernous sinus. The presenting symptoms are severe frontal headache, periorbital pain, ptosis, and diplopia. Usually, patients with headache and ptosis primarily visit neurologists or ophthalmologists. Only when imaging reveals any intracranial lesion involving paranasal sinuses, these patients get referred to otorhinolaryngologists. We would like to describe here the challenges we faced as otorhinolaryngologist, in diagnosis and management of a case of painful ophthalmoplegia as Tolosa Hunt Syndrome. A 55-year-old male presented to us with complaints of left frontal headache, periorbital pain, diplopia, and ptosis of left eye. Imaging and endoscopic biopsy revealed granulomatous lesion involving cavernous sinus with no evidence of fungal aetiology. Patient responded well to systemic steroid therapy with complete resolution of symptoms and no remission till two years of follow up. Tolosa Hunt Syndrome remains a diagnosis of exclusion. Trans-nasal endoscopic biopsy in selected cases may be contributory to the diagnosis. It responds well to systemic steroid therapy. Although chances of relapse are there yet prognosis is excellent.

Unusual coexistence of Stewart-Treves syndrome and sickle cell anaemia: a case of dual pathology

Chronic lymphoedema can rarely be complicated by an angiosarcoma. This combination called Stewart-Treves syndrome usually observed in upper limb in patients of post-mastectomy with axillary lymph node resection. Here, we report a male patient who had a 10-year history of right leg elephantiasis. Later on, he developed two large ulceronodular masses in the same leg with few satellite nodules in the surrounding skin. With the clinical suspicion of malignancy, a wedge biopsy was performed which revealed histological features of angiosarcoma with sickled red cells. The above knee amputation specimen received further confirmed the histological diagnosis. The investigation for haemoglobinopathy also suggested the presence of sickle cell trait. This report describes a multifocal tumour as a rare manifestation of Stewart-Treves syndrome in a post-filariasis case with sickle cell trait, which is an extremely uncommon combination.

Role of nuclear morphometry in diagnosis of salivary gland neoplasms

BACKGROUND

Fine needle aspiration cytology is an important diagnostic tool in salivary gland cytopathology. However, cytology of salivary gland neoplasms shows diversity with morphological overlap, heterogeneity and subjective variability, posing diagnostic challenge. Nuclear cytomorphometric image analysis turns the subjective criteria into quantitative parameters, which may aid not only in differentiating between benign and malignant tumours but also can aid in categorising challenging cases with morphological overlap.

METHODS

A retrospective analysis of Papanicolaou stained fine needle aspirate smears from 50 patients with salivary gland neoplasms, with available follow-up histopathology, was performed. The aspirates were categorised in to three neoplastic categories of Milan system for reporting salivary gland cytology (MSRSGC) that is benign neoplasm, salivary gland neoplasm with uncertain malignant potential, and malignant. The smears were subjected to cytomorphometric image analysis using Image Pro Software (version 10). Each nucleus was analysed for 13 parameters including aspect ratio, intensity, diameter, perimeter, roundness, area, Feret diameter, circularity, radii, Fournier description and chromatin texture characteristics such as margination, heterogeneity and clumpiness. The data obtained was compared through relevant statistical methods.

RESULTS

The comparative morphometric data obtained for parameters using ANOVA, for the three categories showed statistically significant P values (<0.001). The post hoc test (Games-Howel) test also showed significant P values (<.001).

CONCLUSION

Cytomorphometric image analysis is an important tool in diagnosis of salivary gland neoplasms and can improve the diagnostic accuracy for better treatment and improved prognosis. However, more studies with larger sample size may be needed in future for further affirming its role.

Well-differentiated Squamous Cell Carcinoma Arising in Syringocystadenoma Papilliferum

Syringocystadenoma papilliferum (SCAP) is a hamartoma of apocrine sweat gland origin, occurring predominantly in children, in the head and neck region. SCAP can arise or coexist with both benign and malignant tumors. We report herein an extremely rare case of squamous cell carcinoma (SCC) arising in SCAP growth located in unusual supragluteal region in an elderly Indian male. A wide surgical excision of the growth was performed which upon histopathological examination revealed the confirmatory diagnosis. SCC arising in SCAP is unusual, and only two histologically confirmed cases have been previously reported in the literature. This case report emphasizes about extremely rare malignant transformation of SCAP, which should be kept in mind while evaluating a suspicious skin lesion.

Primary low-grade diffuse small lymphocytic lymphoma of the central nervous system

A 45-year-old Indian woman presented in neurosurgery outpatient with seizures, headache and vomiting for the past 1 month. MRI of the brain was suggestive of a malignant central nervous system (CNS) tumour. Histological and immunohistochemical examinations of stereotactic biopsy of the tumour were diagnostic of a low-grade diffuse small lymphocytic lymphoma of the CNS. No evidence of any occult systemic lymphoma was observed, confirming its 'primary' origin in the CNS. The diagnosis of a low-grade primary CNS lymphoma (PCNSL) is difficult as clinical and neuroradiological features are wide and variable. The clinical course is more indolent than a high-grade PCNSL and thus, a less aggressive and localised targeted treatment could be sufficient rather than the high dose, neurotoxic methotrexate-based chemotherapeutic treatment, recommended for high-grade PCNSL. Histological and immunohistological confirmation is therefore mandatory for early, appropriate treatment and prognostic implications.

Hydatid cyst: unusual presentation as 'breast lump'

Hydatid cyst in the breast is rare. We report a case of hydatid cyst in the breast in a 30-year-old Indian rural woman who presented with a lump in her left breast. MRI findings showed a cystic lesion in the breast. Histopathological examination showed features consistent with hydatid cyst with surrounding adherent pericystic breast tissue showing fibrocollagenisation and inflammatory response. ELISA for echinococcal antigen was also found to be positive. This case emphasises that preoperative diagnosis of hydatid cyst in the breast is difficult and often missed as the breast is a rare site of echinococcal infection and clinical and imaging findings are wide and non-specific. Cytological diagnosis by fine-needle aspiration may not always be possible. Therefore, hydatid cyst in the breast should always be considered in the differential diagnosis of a breast lump and histopathological confirmation is necessary for early and appropriate treatment.

Sclerosing stromal tumour of the ovary presenting as precocious puberty: a rare neoplasm

A 7-year-old Indian girl presented with symptoms of excessive development of breasts, early menarche, growth of pubic hairs, accelerated growth and abdominal distension. On clinical examination, a large right abdominopelvic mass was palpable. MRI revealed a large, heterogeneous, solid and cystic tumour in the right adnexal region, suggestive of an ovarian neoplasm. The hormonal profile showed markedly elevated oestradiol and low follicle-stimulating hormone levels. Clinical diagnosis of precocious puberty with right ovarian mass was concluded. Right-sided salpingo-oophorectomy was performed. Histopathology showed features consistent with sclerosing stromal tumour of the ovary. Postoperatively, signs and symptoms of precocity gradually regressed and her serum oestradiol level came down to normal. This is the first reported case from India.

Reticular schwannoma mimicking myxoid sarcoma

Reticular/microcystic schwannoma is a recently described rare distinctive variant of schwannoma with a predilection for gastrointestinal tract. Its occurrence in soft tissue is extremely rare. We report a case of reticular/microcystic variant of schwannoma in a 55-year-old Indian woman who presented with a painless slow-growing swelling in the right forearm for the past 6 months. MRI findings suggested myxoid sarcoma. However, histological and immunohistochemical findings in the excised specimen were consistent with reticular/microcystic variant of schwannoma. This case report emphasises that the diagnosis of reticular/microcystic schwannoma should always be considered in cases where myxoid sarcomas are suspected as it can mimic malignant myxoid sarcomas, clinically and radiologically, thereby avoiding aggressive intervention and overtreatment.

White-blue pyelocalyceal cyst with hydrotic glomerulonephritis

A 5-month-old male infant presented with a 15 day history of distension of abdomen. On clinical examination, a soft lump was palpable in the left lumbar region. Radiological findings suggested an enlarged non-functional left kidney with ureteropelvic adhesive obstruction. The left renal mass was excised and submitted for histopathological examination. The excised renal mass was cystic with its wall partly white and partly blue. Gross and histopathological findings were diagnostic of a white-blue pyelocalyceal cyst with hydrotic glomerulonephritis. This entity needs to be differentiated from a large number of other cystic diseases of the kidney. Intrauterine screening and diagnosis may be significant for a possible early intrauterine uro-laparoscopic recanalisation of the pyeloureteral obstruction to save the affected kidney.

Tubercular thyroiditis with multinodular goitre with adenomatous hyperplasia: a rare coexistence

A 32-year-old Indian woman presented with swelling in the anterior part of the neck for the last 3 years. Clinical and radiological examination and fine needle aspiration cytology suggested the diagnosis of multinodular goitre. A subtotal thyroidectomy was performed by the surgeon and the specimen was submitted for the final diagnosis. Histological examination of the specimen revealed multiple caseating tubercular granulomas coexistent with multinodular goitre and adenomatous hyperplasia. The sections demonstrated acid-fast tubercle bacteria, confirming the diagnosis of tubercular thyroiditis. This case emphasises that tubercular thyroiditis should always be considered in patients with thyroid swelling or nodule, in countries where the prevalence of tuberculosis is high.

Chemical characterization of various fractions of leaves of Cinnamomum tamala Linn toward their antioxidant, hypoglycemic, and anti-inflammatory property

Cinnamomum tamala (CT) Linn. (Lauraceae) is a component of Indian spices and is also used as antidiabetic agent. Its antioxidant potential was reported by other authors and recently our group has reported its immune-suppressive property. Here, CT leaves were extracted with methanol (CTT) and also with various organic solvents of increasing polarity such as hexane (CTH), ethyl acetate (CTEA), and methanol (CTE) in successive manner by continuous Soxhlet extractor. The active compounds of CTT and CTH were analyzed by GC-MS and most abundant compound (eugenol) was further analyzed by HPLC. These extracts were tested for their free radical (FR) scavenging potential for different FR species, hypoglycemic potential on alloxan-induced hyperglycemia, and anti-inflammatory property in carrageenan-induced paw edema and lipopolysaccharide (LPS)-induced nitric oxide (NO) production in rat peritoneal macrophage culture. Result showed that CTH was the most active fraction toward these parameters, which was parallel to its eugenol and total phenolic content concentration.

Effect of hexane fraction of leaves of Cinnamomum tamala Linn on macrophage functions

The leaves of Cinnamomum tamala Linn (Lauraceae), component of Indian spices are associated with hypoglycemic property in Ayurveda; however, no report is available towards its immunomodulation property, which has been explored here. The dried powder of CT leaves was extracted with hexane and solvent free extract (CTH) was given orally to rats for 10 days, in various doses. Its effect was studied on peritoneal macrophage functions, and was compared with ascorbic acid (1,000 mg/kg, immune-stimulant) and cyclophosphamide (10 mg/kg, immune-suppressant). CTH significantly suppressed phagocytosis activity (EC(50) 2,355 +/- 52.45 mg/kg), reduced production of superoxide (EC(50) 275.91 +/- 10.21 microg/ml) and cellular NADPH (EC(50) 384.959 +/- 4.85 microg/ml) content in concentration dependent manner. It also inhibited LPS induced production of nitric oxide (EC(50) 143.75 +/- 3.40 microg/ml) and iNOS protein expression (EC(50) 183.132 microg/ml). Thus, it could be suggested that non-polar hexane fraction of leaves of C. tamala possesses immunosuppressive property, which is mediated through modulation of innate immunity.