Choroidal Ganglioneuroma: An Unexpected Diagnosis

Introduction/Objective

Ganglioneuromas are rare, fully differentiated, benign neuronal tumors arising from neural crest cells anywhere along the sympathetic nervous system. However, they can undergo dedifferentiation and give rise to malignant neuroblastoma and ganglioneuroblastoma. Choroidal ganglioneuroma is exceptionally rare and usually an unexpected histopathological diagnosis. We report a pediatric patient with neurofibromatosis type 1, who underwent evisceration of a painful blind eye with subsequent histopathological examination confirming a diagnosis of choroidal ganglioneuroma.

Methods/Case Report

A 15-year-old boy with a medical history of neurofibromatosis type 1, plexiform neurofibroma of the right face and right orbit, right optic pathway glioma, and right painful blind eye secondary to congenital glaucoma underwent evisceration of the right eye with placement of orbital implant. On histopathological examination a choroidal lesion was identified adjacent to the pigmented retinal epithelium. This lesion showed proliferation of spindle-shaped cells admixed with clusters of ganglion cells. There were no signs of atypia, necrosis, or pleomorphism. The ganglion cells showed abundant cytoplasm with large vesicular nucleus and prominent nucleoli. The spindle cells were positive for S-100 immunostain and the ganglion cells were positive for synaptophysin. These findings were diagnostic of choroidal ganglioneuroma.

Results (if a Case Study enter NA)

NA

Conclusion

Choroidal ganglioneuroma, in addition to being a clinically unsuspected diagnosis, is exceptionally rare in patients with neurofibromatosis type 1. Medical literature on choroidal ganglioneuroma is sparse, however, it is reported that these benign tumors can locally recur with malignant transformation, and therefore close follow-up is advised.

Rhabdomyosarcoma in Ovary- Pathologist’s Diagnostic Dilemma

Introduction/Objective

Rhabdomyosarcoma is the most common pediatric soft tissue sarcoma. However, rhabdomyosarcoma in the ovary is exceptionally unusual and presents a diagnostic challenge. We report one such case and its clinical and pathological perspective.

Methods/Case Report

16-year-old female presented with an enlarging pelvic mass, abdominal distension, and pain. Imaging revealed a heterogeneous left ovarian mass, right axillary lymphadenopathy, and right-hand soft tissue mass. CA-125 was 1833.0 U/ml. Patient underwent left salphingo-oophorectomy, omentectomy, peritoneal and mesenteric biopsy for ovarian staging, incidental appendectomy, and right axillary lymph node excision with suspicion of ovarian epithelial tumor. Pathological evaluation revealed a 16-cm intact ovary with multiple solid and cystic nodules with areas of hemorrhage and necrosis. Microscopic examination of ovarian tumor showed a high-grade malignant tumor consisting of sheets of small round blue cells with severe cytologic atypia, increased mitoses, and features suggestive of rhabdoid morphology. The other specimens were positive for metastases. The tumor cells were immunopositive for Myogenin and MyoD1 while immunonegative for Cytokeratin AE1/AE3, SF-1, PLAP, SALL4, MelanA, and S-100. INI-1 and BRG-1 demonstrated intact nuclear expression. FISH testing identified rearrangement of the FOX01 gene at 13q14. Based on these findings, diagnosis of alveolar rhabdomyosarcoma was rendered. Currently, the patient is receiving rhabdomyosarcoma chemotherapy treatment and has responded well.

Results (if a Case Study enter NA)

NA

Conclusion

In cases with complex and urgent clinical presentation, where the existence of a primary tumor is unknown and where symptoms attributable to primary ovarian tumor dominate the clinical picture, rhabdomyosarcoma is rarely proposed in the differential diagnoses of small round blue cell tumors of the ovary. At present, the right-hand mass is under evaluation; thus, the true nature of the ovarian mass, primary or metastatic is unknown. Our case illustrates the importance of exact diagnoses, as treatment of rhabdomyosarcoma, is different from other ovarian tumors.

Rapid Progression of Non-Alcoholic Fatty Liver Disease into Cirrhotic Liver in Trisomy 21 Patient: A Case Report and Brief Literature Review

Introduction/Objective

Trisomy 21 (Down syndrome) is the most common chromosomal disorder. Among trisomy 21 patients in the pediatric setting, obesity is one of the most common conditions, with prevalence ranging from 23% to 70%. Trisomy 21 has several risk factors for obesity, including increased unfavorable dietary patterns, lower levels of physical activity, and other comorbidities. Epidemiologic studies found this increase in pediatric obesity along with an increased prevalence of non-alcoholic fatty liver disease (NAFLD). Furthermore, children with trisomy 21 have a higher prevalence of NAFLD than children without trisomy 21, even in the absence of obesity. As per literature, NAFLD is present in 64.3 percent of patients with Trisomy 21.

Methods/Case Report

We present a case of a 17-year-old female with trisomy 21 who was diagnosed with B-cell acute lymphoblastic leukemia (B-ALL) after being admitted due to abdominal pain and decreased appetite. The patient was found to have elevated liver enzymes with abnormal ultrasonography findings. MR images showed fatty liver infiltration with a hepatic fat fraction of 47%. Subsequently, a percutaneous liver biopsy was obtained. Microscopic examination showed minimal hepatic parenchyma with collapsed architecture replaced by abundant steatosis (approximately 90%). Portal triads showed mild lymphocytic inflammation and presence of neutrophils. No fibrosis was confirmed with the trichrome stain. She was then enrolled on AALL1731, a clinical trial for a therapy to treat B-ALL. A 4-month follow-up MR image showed hepatic steatosis. After 9 months, liver biopsy revealed cirrhotic liver along with portal lymphoplasmacytic inflammation, bile duct proliferation and mild macro vesicular steatosis.

Results (if a Case Study enter NA)

NA

Conclusion

This case report signifies the importance of histological evaluation of liver abnormalities to provide better treatment. It is vital to schedule close follow-ups in Trisomy 21 patient polpulation, because NAFLD can transform rapidly into a completely cirrhotic liver escpecially with acute lymphoblastic leukemia on chemotherapy. We also emphasizes early lifestyle modifications, including weight loss and proper diet.

Fibrous Dysplasia of Paranasal Sinuses - An Atypical Presentation

Fibrous Dysplasia is a benign bone disease of unknown etiology. The involvement of the craniofacial skeleton is not uncommon but rarely involves the paranasal sinus. We report a case of fibrous dysplasia of paranasal sinuses, describing its unusual clinical presentation, radiological features, histopathological appearance and surgical management.

Characterization of gibberellin producing strains of Fusarium moniliforme based on DNA polymorphism

The gibberellins are one of the major groups of growth promoting hormones and are secondary metabolites of the fungus Fusarium moniliforme (Perfect stage: Gibberella fujikuroi). Sixteen strains of Fusarium from different geographical regions and different hosts were analysed for their ability to produce gibberellins (GA) and for genetic relatedness by random amplified polymorphic DNA (RAPD). Range of gibberellin production varied between 28.9 to 600.0 mg g(-1) dry weight of mycelium in different strains of Fusarium. RAPD analysis showed completely different pattern between high, moderate and low producing strains. High producers formed nearly identical RAPD patterns, whereas the low and moderate producers gave heterologous amplification patterns. Since Fusarium pallidoroseum was in another group, it was possible to distinguish between different species of the genus Fusarium by RAPD. These investigations may find an application in the diagnosis of unknown Fusarium species and in distinguishing isolates of Gibberella fujikuroi within the section of Liseola.

Growth, CO2 exchange rate and dry matter partitioning in mungbean (Vigna radiata L.) grown under elevated CO2

This study was conducted to determine the effects of anticipated future level of CO2 on growth and dry matter partitioning of mungbean (Vigna radiata). Plants were grown from seedlings to maturity inside the open top chamber under amhient CO2 (350 +/- 25 microL L(-1)) and elevated CO2 (600 +/- 50 microL L(-1)) at Indian Agricultural Research Institute, New Delhi (India). Plants were harvested at 20, 35 and 50 days after germination. Mungbean plants grown under elevated CO2 concentration resulted in greater photosynthetic rate on a leaflet area basis and no acclimation in photosynthesis was recorded due to high CO2. Plants grown under CO, enrichmcnt were taller and attained greater leaf area along with more dry matter than ambient CO2 grown plants at all growth stages. Response to high CO, depends upon the growth stage of the plant and it was more at early growth stages compared to maturity stages. The high CO2 grown mungbean plants also exhibited increased root growth along with stem and leaves. There was a substantial increase in pod number and seed number/plant under elevated CO2 conditions. The increase in dry matter and growth of root, stem and leaves proved that CO2 enrichment of the atmosphere can stimulate photosynthetic rate which can ultimately lead to an increase in dry matter and growth.

Identity cards for patients infected with HIV?

Dr A C Srivastava has written to us to describe a case that raises the suggestion that people infected with the human immuno-deficiency virus (HIV) should carry identity cards. We asked two physicians, a general practitioner working with patients with the acquired immune deficiency syndrome (AIDS), and a general practitioner with a special interest in medical ethics to respond to the broad issues raised by Dr Srivastava's letter.

A taxonomic and ecological study of candidosis

A total of 450 yeast isolates were obtained from up to 34 sites on 59 human subjects. The yeasts were characterized using morphological features and assimilation tests. Ten species were identified but, of these,Candida albicans andCandida parapsilosis were the most common and accounted for 84% of the isolates. An examination of the biotypes of the various species indicated a much greater diversity in the yeast microflora than that detected by species identifications alone. Fifty-five biotypes were differentiated and it is suggested that these could be regarded as distinct taxonomic or ecological entities.

Survival of gonococci in urethral secretions with reference to the nonsexual transmission of gonococcal infection

The survival of gonococci on various materials contaminated with gonococcal pus and stored at room temperature was studied. Gonococci were recovered for up to 3 days from a wide variety of hard and soft materials. It is possible that gonorrhoea is transmitted nonvenereally more often than is usually acknowledged, and these results may have medicolegal and social significance.

The fingerprints of the Sayyads of Lucknow, Uttar Pradesh

A study of the fingerprints of the Sayyads of Lucknow district, Uttar Pradesh, has given the following frequencies: whorls 40.87%, loops 56.33% and arches 2.80%. The mean pattern intensity is 13.81 ± 0.27, showing no significant differences with neither the upper nor the lower-caste Hindus of U.P., excepting the Purabia Chamar.

As for the ridge count, the Sayyads show a mean of 151.52 ± 3.62, which is highest as compared to Hindu populations of U.P. However, no significant differences are apparent between the Sayyads and Brahmins, Rajputs, and Ahirs. The Sayyads are found to differ significantly from the earlier Muslim sample reported by Singh (1961).

A comparison of the Sayyads with their coreligionists residing in the distant lands from India fails to reveal consistent dermatoglyphic affinities.