bluuebunny/crossref_metadata_2025 huggingface dataset:
A rare case of cerebellar pilomyxoid astrocytoma associated with neurofibromatosis-1 in a young female; case report highlighting immunohistochemical features
Authors: Sinai Khandeparkar Siddhi Gaurish , Gosavi Shital Subhash , Gogate Bageshri P. , Talathi Nikhil
Published: May 2024

Pilomyxoid astrocytoma (PMA), a distinct clinico-histopathological entity in the World Health Organization classification 2007, tends to be locally aggressive, with higher chance of leptomeningeal dissemination, recurrence, and poor prognosis. PMA is generally seen in young children and tend to occur in the hypothalamic-chiasmatic region. Their presence in other parts of the brain in the non pediatric age group is uncommon. To the best of our knowledge we are presenting first case of cerebellar PMA associated with neurofibromatosis 1 (NF1) in a 40-year- old female, with immunohistochemical study.
Role of orthopedia homebox protein in subclassification of pulmonary carcinoid tumors: Retrospective analysis of 110 cases
Authors: Çetin Mehmet , Fındık Göktürk , Demirağ Funda , Türk İlteriş , Aydoğdu Koray
Published: May 2024

Background:

Orthopedia homeobox protein (OTP), highlighted as a sensitive and specific marker for pulmonary carcinoids, may provide a more objective criterion for subclassification.

Materials and Methods:

A total of 110 patients who underwent surgery for pulmonary carcinoids (2009–2019) were included. Gender, age, application complaint, tumor diameter and location, typical and atypical tumor type, lymph node involvement, stage, recurrence, and survival data were evaluated retrospectively with OTP nuclear staining.

Results:

The sensitivity of OTP was 66.4%. OTP in subclassifying pulmonary carcinoids was not significant. There was no significant relationship between OTP and lymph node involvement, recurrence, and survival.

Conclusion:

OTP does not provide significant results in the subclassification of typical and atypical carcinoid tumors and the evaluation of recurrence and survival of carcinoid tumor cases.
Primary anaplastic large cell lymphoma of caecum and ascending colon
Authors: Radha Sistla , Afroz Tameem , Reddy Ravishankar
Published: May 2024

Lymphomas are hematological malignancies with a wide variety of histological subtypes, varied clinical manifestations and behaviour and have a wide range of organ involvement. About 40 per cent of lymphomas are extra nodal. The most common extra nodal site is gastrointestinal tract (GIT). In the GIT, stomach is the most common organ involved accounting for 50–60 per cent of the lesions. Colorectal lymphomas are rare and account for 15–20 per cent of GIT lymphomas. They constitute 1 per cent of colorectal malignancies. Most common histological type of lymphoma involving GIT is diffuse large B-cell lymphoma, followed by MALT lymphoma; T-cell lymphomas are very rare and have an incidence of 3 per cent of Non Hodgkins Lymphoma (NHL). We report a case of anaplastic large cell lymphoma in the caecum and ascending colon with review of literature.
Inherited epidermolysis bullosa dystrophica and squamous cell carcinoma- A case report
Authors: Gayathri E. , Anbukkarasi K. , Lilly S. Mary
Published: May 2024

Epidermolysis bullosa dystrophica (EBD) is an inherited disease of the structural proteins in the upper dermis, characterized by blister formation at the site of trauma followed by scarring. Skin fragility and blistering are the hallmarks of this disease. Cutaneous squamous cell carcinoma (cSCC) is a dreadful complication in the epidermolysis bullosa (EB) patients and common cause of death. The recent advances in distinct tumor microenvironment explain the aggressive nature of SCC in recessive Recessive Dystrophic Epidermolysis Bullosa (RDEB) patients and the use of collagen VII re-expression as a possible therapeutic measure. Regular follow-up is a must in preventing complications.
Leonine facies
Authors: Hasan Faheema , Parashar Yatendra , Rao Ram N. , Kashyap Rajesh
Published: May 2024

We report a 52-year-old man who presented with erythroderma and nodular lesions on face manifesting as “Leonine facies”. He had impaired sensation over the face and was initially diagnosed to have lepromatous leprosy and was treated with antileprosy drugs. Investigations showed a total Leukocyte count of 550 X 109/l with 90% atypical lymphoid cells with prominent central nucleolus suggestive of prolymphocytes. On flow cytometry, these cells were positive for cytoplasmic CD3, CD2, CD5, CD7, CD4, and CD38 (dim) and were negative for CD1a and TdT and diagnosis of T-prolymphocytic leukemia was made.
Primary cutaneous amyloidosis
Authors: Sinha Akanchha , Manjunath G. V. , Basavaraj Vijaya
Published: May 2024

Background:

Primary cutaneous amyloidosis (PCA) comprises several forms of localized cutaneous amyloidosis characterized by amyloid deposits occurring at or near dermal–epidermal junctions. Immunohistochemical studies have shown the expression of cytokeratin (CK) suggesting that it has an epidermal origin.

Objectives:

To study the clinicopathological features of PCA and expression of CK5/6 and correlate it with Congo red stain.

Materials and Methods:

A total of 30 histologically proven cases of PCA were studied. Congo red staining and immunohistochemical expression of CK5/6 were analyzed.

Statistical Analysis:

The qualitative data has been expressed as proportions and the quantitative data has been expressed as mean ± SD. All data was analyzed using the Statistical Package for Social Sciences (SPSS) software version 22.

Results:

Deposits of amyloid in papillary dermis were seen in all 30 cases. Mild focal basal cell vacuolar degeneration and apoptotic bodies in epidermis were seen in six cases. The presence of pigment cells in dermis were seen in 26 cases. CK5/6 showed weak/mild immunopositivity in nine cases, moderate in 20 cases, and strong in one case.

Conclusion:

The presence of dermal melanophages interspersed within eosinophilic deposits gives a clue to the diagnosis. Congo red stain highlights the deposits and visualization under polarized light gives apple green birefringence which is diagnostic of amyloid. Staining of amyloid deposits by CK5/6 proves that the amyloid is of keratinocyte origin. There was 100% sensitivity with Congo red and CK5/6. Thus, CK5/6 can be used as an adjunct tool to Congo red stain in the diagnosis of primary cutaneous amyloidosis.
A rare case of smear positive tuberculous arthritis
Authors: Sureshkumar Mathavi , Rajamani Shanmugasundaram , Ravindran Vijayaragavan , ArvindhKrishnan E.
Published: May 2024

TB arthritis is a very rare extrapulmonary presentation in an immunocompetent host. It is usually the result of direct hematogenous spread from the primary focus. Our patient presented with pain and swelling of the right knee for 6 months. The blood investigations and CT chest revealed findings consistent with active tuberculosis. Synovial fluid was positive for acid-fast bacilli (AFB) which is a very rare finding. Cartridge-based nucleic acid amplification test (CBNAAT) revealed Mycobacterium tuberculosis and sensitivity to rifampicin. Establishing the diagnosis of Mycobacterium tuberculosis beyond doubt is very important, and early initiation of antitubercular treatment (ATT) is important as delay in treatment may lead to irreversible damage to the joint and restriction of joint mobility.
Segmental filiform-polyposis in a treated case of ulcerative colitis, colon
Authors: Gurung Niteeka , Goyal Surbhi , Aggarwal Anil , Puri Amarender Singh , Sakhuja Puja
Published: May 2024

Inflammatory bowel disease is broadly classified into Crohn's disease and ulcerative colitis. The standard criteria to distinguish between the two is the manner of the involvement of the bowel, with the former showing classical skip lesions and the latter having continuous involvement of the colon, most commonly affecting the rectum. However, some cases exhibit overlapping features. Herein, we report a treated case of ulcerative colitis presenting with patchy involvement of the colon in the form of peculiar segmental filiform polyposis spanned abruptly by an intervening normal mucosa. The clinico-radiologically suspicion of carcinoma colon with Crohn's colitis was considered. The clinicians and pathologists must be aware of such atypical presentations and should not be misled to change the diagnosis from ulcerative colitis to Crohn's colitis on the post-treatment resection specimens or endoscopic biopsies solely in view of the patchy filiform polyposis (FP), which poses a drastic impact on the patient's management.
Cytogenetics and FISH negative cryptic acute promyelocytic leukemia with CD56 expression
Authors: Arumugam Jhansi Rani , Karthik Bommannan B. K. , Kalaiyarasi Jayachandran Perumal , Sundersingh Shirley
Published: May 2024

Acute promyelocytic leukemia (APL) is characterized by reciprocal translocation t(15;17)(q22;q21) and has a favorable prognosis upon immediate recognition and treatment. However, rare cases of APL show a cryptic insertion of retinoic acid receptor alpha (RARA) gene into promyelocytic leukemia (PML) gene which is negative both by fluorescence in situ hybridization (FISH) and conventional cytogenetics (CC). Morphology, cytochemistry and flow cytometry play a key role in early identification of such cases. Polymerase chain reaction (PCR) remains the most efficient diagnostic modality for detection of cryptic APL and other variants. It is important to identify these cases as they show beneficial response to retinoids and favourable prognosis. We herein present a rare case of cryptic APL negative by FISH and conventional cytogenetics but positive for PML-RARA by PCR.
Nine cases of soft tissue keratocysts arising from buccal mucosa and lateral fascial deep region
Authors: Khare Parul , Sun Jingjing , Wang Lizhen , Tian Zhen , Zhang Chunye , Hu Yuhua , Xia Ronghui , Li Jiang
Published: May 2024

Background:

Soft tissue keratocysts (SKC) are extremely rare and show similar microscopic morphology to keratocystic odontogenic tumor. The aim was to investigate immunohistochemical (IHC) features and origin of SKCs developing in buccal mucosa and lateral facial deep region.

Material and Methods:

Expression of CK19, CK10/13, Ki67, Cyclin D1 and Osteopontin (OPN) of 9 SKCS were investigated using IHC. Forty different types of cysts in jaw/soft tissue were used as control. Follow-up was performed.

Results:

CK10/13 positivity occurred more frequently and intensely in SKC and intraosseous parakeratinized odontogenic keratocysts (COKC). However, OPN positivity was observed only in COKC.

Conclusion:

This is the largest case series of SKCs; along with first attempt to investigate the expression of OPN on SKC. Given the microscopic and immunohistochemical features, we prefer the view that SKC is odontogenic origin but represents the soft tissue counterpart of COKC, since their expressions of OPN were extremely different.
A study to analyze the pattern of synovial lesions from synovial biopsies in a tertiary care centre
Authors: Tevatia Manvir Singh , Goyal Neeti , Baranwal Ajay Kumar , Mishra P.S. , Gupta Arun , Sharma Vyom , Agarwal Mohit , Gupta Prashant Sen , Dangwal Vidhu
Published: May 2024

Introduction:

Synovium has been documented as a primary site of inflammation and a major effector organ in a variety of joint diseases. Study of simple technique like synovial biopsy can help in early diagnosis and treatment of diseases significantly improving outcome of patient in cases of rheumatoid arthritis, osteoarthritis, etc., Only limited data exist on utility of synovial biopsies.

Aim and Objectives:

To analyze the pattern of synovial lesions to differentiate between different kinds of arthritis. Also, to identify early stages of arthritis so as to prevent unnecessary invasive surgical procedure.

Materials and Methods:

It's a retrospective study to analyze 103 cases of synovial lesions diagnosed in last five years at a tertiary care orthopedic center. All synovial biopsies obtained mainly by open method and few by arthroscopic method, that came to the Dept of Pathology were included. Lesions were classified into four categories that is, inflammatory joint diseases, degenerative joint diseases, tumor-like conditions and tumors.

Results:

Age group most affected was between 61 and 70 years, with male predominance. Osteoarthritis (OA) was the most common histopathological diagnosis. Early OA tissues showed greater lining layer thickness, vessel proliferation, and inflammation, while surface fibrin deposition along with fibrosis was noted in later stages.

Conclusion:

The histo-morphological observations made in this study may have important therapeutic implications for some patients during the early evolution of arthritis and could prevent unnecessary operative intervention of later stages.
Age-wise reference range of immature platelet fraction in neonates
Authors: Krishnan V. P. , Golwala Zainab , Kanvinde Purva , Patel Swati , Rao Sudha , Mudaliar Sangeeta
Published: May 2024

Immature platelet fraction (IPF) is a quantification of immature platelets in the circulation reflecting the state of thrombopoiesis in the marrow. Normal reference range for IPF has been established in adults. Reference intervals in neonates are highly dependent on gestational age of the neonate. Complete blood counts (CBC) with IPF of all neonates admitted in neonatal intensive care unit (NICU) were analyzed using Mindray BC-6800 Auto Hematology analyzer. Platelet count of less than 150 × 10^9/L was assigned as thrombocytopenia. Neonates were divided into four groups as per the corrected gestational age (CGA) on the day of CBC analysis: 28–32 weeks, 32–34 weeks, 34–37 weeks, and >37 weeks according to World Health Organization (WHO) classification. Mean, standard deviation, and 95% confidence interval for IPF was calculated in each group and reference range for IPF was derived. Mean IPF in neonates with normal platelet count was term––3.58 (95% CI 3.29 to 3.87), late preterm Neonates (34–37 weeks)––4.14 (95% CI 3.82 to 5.0), moderate preterm neonates (32–34 weeks)––4.14 (95% CI 3.46 to 4.82), and in Very Preterm neonates (28–32 weeks)––IPF of 5.51 (95% CI 3.95 to 7.07). We aimed to establish a reference range for IPF in neonates of different gestational age groups. The IPF values in neonates were comparable between hematology analyzers in neonates with normal platelet counts.
Chromophobe renal cell carcinoma with rare distant metastasis
Authors: Keloth Thara , Srinivas Bheemanathi Hanuman , Ganesh Rajesh Nachiappa , Ramesh Andi Sadayandi
Published: May 2024

Metastasis accounts for the most common tumor of the central nervous system (CNS) in adults. Renal cell carcinoma (RCC) is one of the common carcinoma showing brain metastasis, with a predilection for clear cell variant. Chromophobe RCC (ChRCC) in contrast to clear cell RCC shows far less common distant metastasis. When they metastasize, commonly involve the liver, lungs, and lymph nodes. ChRCC metastasizing to the brain is extremely rare. Isolated brain metastasis from RCCs is also uncommon. We report an unusual case of a 54-year-old woman with ChRCC with isolated metastasis to the brain, 2 years after radical nephrectomy for renal mass.
Follicular Dendritic cell sarcoma of caecum in a young boy presenting as Intussusception
Authors: Jagdale Rakhi V. , Pol Jaydeep N.
Published: May 2024

Background:

Follicular dendritic cell sarcoma (FDCS) is a rare tumor derived from follicular dendritic cells (FDC) occurring in lymph nodes and extranodal sites. It is usually regarded as an indolent tumor with a tendency of local recurrence but a low risk of metastasis. Common extranodal sites are liver, lung, tonsil, spleen, soft tissue, and mediastinum. Extranodal FDCS of gastrointestinal tract (GIT) is exceedingly rare, with just 36 cases reported in the literature.

Methods:

We report an unusual case of FDCS of caecum in a 13-year-old boy who presented as intussuception. On histology, it posed a diagnostic challenge for us. An inconclusive initial immunohistochemistry (IHC) lead us to suspect FDCS which was confirmed by FDC markers.

Conclusions:

The diagnosis of FDCS at extranodal site like GIT is all the more challenging because of its rarity, morphologic heterogeneity, and lack of awareness.
Ectopic thyroid in left parotid gland with an orthotopic thyroid gland
Authors: Singh Anshul , Yadav Kusum , Kumar Manoj , Misra Vatsala
Published: May 2024

Benign ectopic thyroid tissue within the parotid gland is very rare with only one case reported till date in the world literature. We report a case of ectopic thyroid in the left parotid gland with an orthotopic thyroid in an elderly female, who was presented to us with the simultaneous onset of right-sided thyroid swelling and left parotid swelling for 6 months. Fine-needle aspiration cytology (FNAC) was done from both the swellings and a diagnosis of Hurthle cell neoplasm metastasizing to the left parotid gland was initially made. However, histopathological examination along with the immunohistochemistry (IHC) panel proved it to be an ectopic thyroid in the parotid. The case is being documented here for its rarity as well as an unusual presentation so that the readers are aware of this entity and the complete workup required to prevent diagnostic pitfalls.
Helping medical students to learn pathology more effectively
Authors: Bhusnurmath Shivayogi R. , Bhusnurmath Bharti S. , Goyal Shefali B.
Published: May 2024

Context:

Teaching methods in pathology for undergraduate medical students are not effective.

Aims:

To document measures that can be adopted by individual teachers that can excite the interest, participation of the students and help them learn pathology in a clinical reasoning context.

Settings and Design:

Medical students in a large international medical school with class sizes of 700–900 were taught the pathology course in a period of sixteen weeks for two cohorts of students each year over a period of twenty years.

Subjects and Methods:

Specific learning objectives were devised to achieve higher levels of cognitive domain including interpretation, analysis and problem solving of clinical data of patients related to the objectives. The teaching sessions were modified to provide for maximum active participation by students with effective feedback at multiple points. Additional learning tools like concept maps, clickers, modified essay questions, flipped classrooms, clinicopathological conferences, directed self-learning activities were included. Learning objectives and assessment tools for professional behavior and communication skills were included.

Results:

The students actively participated in all the learning activities with enthusiasm and achieved the objectives as reflected in the performance in the in-house examinations and the USMLE step one examination which tests clinical vignette-based problem-solving principles of which around 70% are related to pathology.

Conclusions:

The teaching sessions in pathology were useful and effective with adaptation to interactive, clinical reasoning platforms for teaching and assessment.
Role of HER2neu expression in gastric cancer
Authors: Sukanya J. S. , Raj Pavithra Vittal , Thanka J.
Published: May 2024

Background:

Gastric cancer is one of the most common cancers in the world and is responsible for over a million deaths. Gastric cancer broadly consists of two main histological types, diffuse and intestinal, and can be further classified as proximal (cardia) and distal (corpus and pylorus) cancers. The presence of Her2neu in certain cancers including gastric cancers has helped in throwing some light on the prediction of prognosis of the tumours. This study was carried out to assess and evaluate the role of Her2neu immunohistochemical expression in gastric cancers.

Methodology:

This study was carried out as a retrospective study on paraffin blocks of 70 gastrectomy specimens in the pathology department of our hospital. After the histological assessment and interpretation of data, appropriate blocks were chosen and sections of 3 micron thickness were cut and immunohistochemical staining of Her2neu was done and scoring was carried out.

Results:

We found that gastric cancer occurred predominantly in men as compared to women. Antrum was the most common site involved in gastric cancer (60%). In our study Grade 2 predominated (54%) than Grade 1 (4.2%) and Grade 3 (41%). According to the scoring system of Her2neu expression by immunohistochemistry in gastric cancer it was positive (3+) in 8 cases (11.4%), equivocal (2+) in 10 cases (14.3%) and negative (0+,1+) in 52 cases (74.3%). Her2neu was seen positive 13.7% of intestinal type tumours and in only 5.3% of diffuse type of tumours (P < 0.05).

Conclusion:

Her2neu testing in gastric adenocarcinomas especially in histologically identified early gastric carcinoma is recommended.
Lipid-rich carcinoid of the appendix
Authors: Lanjewar Dhaneshwar N. , Parmar Riddhi A. , Sharma Bhawana , Thacker Mansi , Upadhyay Jigna S.
Published: May 2024

The carcinoids are the most frequent tumors arising from the appendix, in majority of the cases, these are asymptomatic and are discovered after appendectomy. The lipid-rich carcinoid, also known as clear cell carcinoid; is histologically characterized by the presence of clear vacuoles in the cytoplasm of tumor cells. Only 24 cases of lipid-rich carcinoid of the appendix are described in the English literature, and there is no report of this entity in the Indian literature. In this report we describe a first case of lipid-rich carcinoid of the appendix in India and also present a review of the literature.
Rhabdomyolysis with myoglobin-induced acute kidney injury
Authors: Samuel Hanock Unni , Balasubramaniyan T. , Thirumavalavan S. , Vasudevan C. , Senthil Kumar R. P. , Murugesan V. , Abraham Anila
Published: May 2024

Rhabdomyolysis is a potentially life-threatening clinical syndrome characterized by the breakdown of skeletal muscle cells and release of creatine kinase (CK), lactate dehydrogenase (LDH), and myoglobin into the plasma and interstitial space. Rhabdomyolysis can occur due to a variety of causes and acute kidney injury (AKI) is one of its most dreaded complications occurring in 33%–50% patients. The main pathophysiology of renal injury is due to vasoconstriction, intraluminal casts, tubular obstruction, and direct myoglobin toxicity. As the symptoms are nonspecific, a high level of suspicion is required in the mind of the treating physician. Early diagnosis and prompt management with fluid resuscitation, initiation of renal replacement therapy (RRT), and elimination of causative agents can help prevent complications. We hereby report four interesting cases of this clinical syndrome with emphasis on the causative agents.
Eosinophilic solid and cystic renal cell carcinoma
Authors: Kamboj Meenakshi , Gupta Gurudutt , Pasricha Sunil , Rawal Sudhir , Sharma Anila , Durga Garima , Mehta Anurag
Published: May 2024

Eosinophilic solid and cystic renal cell carcinoma (ESCRCC) is an under-recognized, emerging new entity of sporadic renal neoplasms, with an approximate incidence of 0.2% of renal tumors. A total of 60 cases have been reported in the literature till date. ESCRCC are usually seen in adult females, with a low stage and indolent behavior, and rare incidence of recurrence or metastasis. They are solid and cystic tumors with variably sized cysts resembling eosinophilic RCC, showing a characteristic positive immune-expression for PAX-8, CK20 (in ~80% cases) and/or Melan–A (in ~6.7%), with negative CK7 and CA-IX expression. They consistently harbor TSC1 or TSC2 mutations in all tumors, which is a proposed molecular marker for this entity. We here present the first reported case of this rare tumor from India. The tumor was positive for PAX-8, and showed diffuse strong positivity for Melan-A, while was negative for CK7 and CK20. It was an early-stage tumor (T1), managed with partial nephrectomy, with no evidence of any recurrence/metastasis after 1 year of follow-up.
A rare case of malignant peripheral nerve sheath tumor of pleura and review of literature
Authors: Amrith B. P. , Pasricha Sunil , Jajodia Ankush , Babu Koyyala Venkata Pradeep , Batra Ullas
Published: May 2024

Malignant peripheral nerve sheath tumor (MPNST) is a type of soft tissue sarcoma arising from peripheral nerves. They can be found in isolation, but about half of the cases are associated with neurofibromatosis type 1 (NF1), an autosomal dominant genetic disorder. They usually arise from the nerve plexus in extremities and trunk. MPNSTs arising from the viscera or internal organs are very rare. We hereby report a rare case of sporadic MPNST arising from pleural surface in a middle-aged male. The diagnosis of such a rare entity involved multimodal investigations with consideration of wide differential diagnosis.
HER2 testing by immunohistochemistry in breast cancer
Authors: Md Pauzi Suria Hayati , Masir Noraidah , Yahaya Azyani , Mohammed Fazarina , Tizen Laim Nur Maya Sabrina , Mustangin Muatamarulain , Aizudin Azimatun Noor , Talib Arni , Teoh Kean-Hooi , Karim Norain , Oy-Leng Jacqueline Wong , Rajadurai Pathmanathan
Published: May 2024

Background:

Human epidermal growth factor receptor 2 (HER2) over-expression in breast cancer is associated with aggressive tumor behavior and predicts response to targeted therapy. Accurate HER2 result is paramount for optimal patient management. However, routine HER2 immunohistochemistry (IHC) testing are subjected to intra- and inter-laboratory variability.

Objective:

This study aims to determine inter-laboratory variation in HER2 IHC testing through a slide-exchange program between five main reference laboratories.

Method:

A total of 20 breast carcinoma cases with different known HER2 expression and gene status were selected by the central laboratory in five testing rounds. Three unstained tissue sections from each case were sent to participating laboratories, which immunostained and interpreted the HER2 immunohistochemistry result. One of the stained slides was sent to one designated participating laboratory for evaluation. Results were analyzed by the central laboratory.

Results:

A complete concordance was achieved in six IHC-positive and six IHC-negative cases, its gene status of which was confirmed by in-situ-hybridization (ISH) study. The discordant results were observed in six equivocal cases, one negative case and one positive case with a concordance rate of 50–88.3%. Interestingly, the negative discordant case actually displays tumor heterogeneity. Good inter-observer agreement was achieved for all participating laboratories (k = 0.713-1.0).

Conclusion:

Standardization of HER2 testing method is important to achieve optimum inter-laboratory concordance. Discordant results were seen mainly in equivocal cases. Intra-tumoral heterogeneity may impact the final HER2 IHC scoring. The continuous quality evaluation is therefore paramount to achieve reliable HER2 results.
Traumatic Perforation of Tympanic Membrane
Authors: Puttamadaiah G. M. , Bhanuprakash P. N. , Viswanatha B. , Patil Kartik Irappa , Menon P. Architha
Published: May 2024

Introduction:

Traumatic perforation of tympanic membrane (TM) is caused by increase in air pressure due to slapping, road traffic accident, blast injury, syringing, trauma by ear buds, etc., The incidence has been increased in recent times due to increased domestic violence and road traffic accidents. Hence, there is a need for early identification, evaluation, and management to reduce the morbidity.

Objectives:

The objective of the study was to describe etiologies of traumatic perforation of TM, to assess the findings of pure tone audiometry (PTA) among patients with traumatic perforation of TM, and to determine the outcome.

Materials and Methods:

This study was done between November 2017 and May 2019 in the department of ENT at Bangalore Medical College and Research Institute on 88 patients with traumatic perforation of TM who were subjected to otoscopic examination, tuning fork tests, and PTA. Patients were followed up on weekly basis.

Results:

Out of 88 patients, 33 patients (37.5%) were in the age group of 21–30 years. Fifty-four were males (61.36%) and 34 were females (38.63%). Slapping is the most common mode of injury with 50 (56.8%) patients. Left ear 55 (62.5%) was more commonly involved than right ear 33 (37.5%). Small perforation 55 (62.5%) was more common followed by medium-sized perforation 25 (28.4%) and large perforations were the least 8 (9.1%). Multiple quadrants were involved in 33 patients (37.5%). Posteroinferior quadrant was most commonly involved. Deafness (75%) was the most common symptom involving 66 patients. Average time taken for spontaneous healing was 37 days. Mean hearing improvement compared between hearing loss at the time of trauma and after 3 months was 13.18 ± 7.05 dB, which is statistically significant (P = 0.0001).

Conclusion:

Traumatic perforation of TM spontaneously healed in 80 participants (90.90%), whereas eight participants (9.09%) underwent surgery, i.e., tympanoplasty.
Patient-Related Long-Term Outcome Measures After Mastoid Surgery at A Tertiary Care Center of North India
Authors: Patro Sourabha Kumar , Panda Naresh K. , Rathod Ramya
Published: May 2024

Background:

Long-term postsurgical follow-up in chronic otitis media (COM) is crucial in otologic practice for outcome assessment. Validated questionnaires for the same are robust alternatives when physical visits are not feasible such as the current COVID-19 pandemic and we present our findings of outcome assessment using COM outcome test (COMOT)-15 questionnaire through nonphysical mode.

Materials and Methods:

A retrospective analysis of a cohort of 112 patients of COM who underwent surgery by the single senior otology surgeon between 2009 and 2019 was done using COMOT 15 questionnaire through telephonic methods to circumvent the need of office visits.

Results:

Fifty out of 112 patients could be contacted and consented for the assessment and their COMOT-15 scores were obtained. The numbers of patients with any otologic symptoms and their need for consultations, except hearing loss were significantly less. One-third of the patients had mild to moderate residual hearing loss and its quality of life impacts, although the same neither was statistically significant nor required increased numbers of consultations.

Conclusion:

Bothering symptoms and the need for a frequent visit to the doctor is significantly less with adequate clearance of disease and mastoid obliteration in cases of canal wall down procedures. The residual mild-to-moderate hearing loss are not significant and manageable with day-to-day activities. Successful outcome of COM surgery needs long-term follow-up and evaluation by all practicing otologic departments and surgeons which can well be done through nonphysical modes in unprecedented situations like the current times.
Posterior Canal Wall Reconstruction in Squamosal Type of Chronic Otitis Media
Authors: Srivastava Abhinav , Mohan Chander
Published: May 2024

Introduction:

The removal of Cholesteatoma remains a matter of debate with varying opinion, but the primary objectives remain complete eradication of the disease and creation of a safe ear. Restoration of hearing is secondary objective. Reconstruction of posterior canal wall can be attempted after complete removal of cholesteatoma with different materials.

Aim and Objectives:

The aim of the study was to study the outcome of posterior canal wall reconstruction in patients undergoing modified radical mastoidectomy.

Materials and Methods:

This prospective interventional cross-sectional study has been done on forty patients in the department of otorhinolaryngology and head-neck surgery, in a tertiary care hospital in Western Uttar Pradesh with an enrolment period of 1 year and a minimum of 1-year follow-up.

Results:

In the present study, the success rate of canal reconstruction was 85%. The most common site of middle ear cleft which was found to be mostly affected by cholesteatoma was aditus in 94.12%, followed by posterior attic, middle ear, and sinus tympani accounting for 91.18%, 82.35%, and 79.41%, respectively. Incus was found to be the most common ear ossicle affected. A statistically significant result was found in the pre- and post-operative average hearing loss and air-bone gap.

Conclusion:

Canal reconstruction in patients undergoing canal wall down mastoidectomy is a good option in patients presenting with limited disease of squamosal type of chronic otitis media. A candidacy criterion has been proposed for deciding patients in whom canal reconstruction can be tried.
Auditory Implants in Individuals with Goldenhar Syndrome
Authors: Umashankar Abishek , Krishnaramanujam Suganthi , Chandrashekaran Pachaiappan
Published: May 2024

Goldenhar syndrome is a rare genetic disorder that includes various signs and symptoms, including facial, auricular, ocular, vertebral, renal, lung, cardiovascular, and limb deformities. Such individuals have severe-to-profound sensorineural hearing loss as a common feature. However, implanting them with either cochlear implants or brainstem implants is challenging, and the article discusses literatures that have carried out these procedures based on a systematic review of case reports. Databases such as PubMed, J-Gate, and Google Scholar were used to extract the articles related to auditory implantation and Goldenhar syndrome.
Otogenic Cerebellar Abscess with Cholesteatoma
Authors: Vybhavi M. K. , Srinivas V. , Prashanth V. , Muddaiah Dechu , Lavanya M.
Published: May 2024

Otogenic brain abscesses are the second-most common intracranial complication observed in patients of chronic otitis media, more frequently occurring with cholesteatoma. Due to the availability of antibiotics and advanced imaging techniques, the incidence and mortality of otogenic brain abscesses has reduced. Nevertheless, we still come across cases of otogenic brain abscess in modern times. Here, we report a case of the left ear chronic otitis media, squamosal type with intracranial complication of the left cerebellar abscess in a 14-year-old girl. Magnetic resonance imaging of the brain showed a thick-walled cystic lesion in the left cerebellar hemisphere measuring 41 mm × 28 mm × 26 mm suggestive of brain abscess. High-resolution computed tomography of the temporal bone showed soft-tissue density in the left mastoid air cells, in epitympanum, and mesotympanum encasing the left middle ear ossicular chain, suggestive of chronic otomastoiditis with possible underlying cholesteatoma. The patient underwent left retromastoid suboccipital craniotomy and excision of brain abscess followed by the left modified radical mastoidectomy 1 month later. Follow-up scan at 6 months showed no recurrence or any residual disease. Hence, timely surgical intervention for complicated chronic otitis media gives satisfactory results.
Cone-Beam Computed Tomography Evaluation of Morphology and Orientation of Styloid Process and Prevalence of its Elongation in Age and Gender
Authors: Priyadharshini S. , Gopal K. Saraswathi , Srinivasan Srividhya
Published: May 2024

Background:

Styloid process (SP) is a cylindrical, cartilaginous bone that projects downward, medially from petrous part of the temporal bone on right and left sides. There are variations noted in the SP which results in impingement on nearby vital structures and can cause annoying orofacial pain. Cone-beam computed tomography (CBCT) gives an accurate image without superimposition of adjacent structure.

Aim:

This study aims to investigate the three-dimensional orientation, length, and morphological variations of the SP using CBCT.

Materials and Methods:

One hundred and twenty CBCT images from the age of 20–60 years were retrieved and further divided into three groups (Group I, II, III). The length, anteroposterior angulation (APA), and mediolateral angulation (MLA) of styloid were measured along with its type of classification of elongation and calcification pattern were recorded. Statistical analysis was done using SPSS version 28.

Results:

In our study, the mean length, APA, and MLA of both right and left SPs were found to be 3.05 ± 1.1 cm, 31.7° ± 6.2°, and 67.3° ± 5.8°, respectively. 41.7% was the prevalence of elongation. No significant difference in prevalence, among age group observed. Type I and Type II classification of elongation was predominantly seen. Type B pattern of calcification was found to be statistically highly significant (P = 0.000) on both right and left sides.

Conclusion:

Diversity of SP in length, angle, and morphology can occur within individuals across populations and among gender; these variations need to be considered in symptomatic patients.
Ischemia-Modified Albumin Levels in Patients with Bell's palsy
Authors: Cirik Ahmet Adnan , Evcimik Muhammed Fatih , Ülfer Gözde , Yiğitbaşi Türkan , Aktaş Öztürk
Published: May 2024

Background:

Although several causes have been regarded as possible including viral, autoimmune, inflammatory, and vascular ischemia, the accurate etiology and pathophysiology of Bell's palsy (BP) remain unclear. The aim of the present article was to determine whether serum levels of ischemia-modified albumin (IMA) are associated with BP and if there is a posttreatment change in IMA levels.

Materials and Methods:

This was a prospective study enrolling 23 patients (10 males and 13 females; mean age: 44.71 ± 16.72 years; and range, 20–57 years) and 23 healthy individuals (12 males and 11 females; mean age: 37.91 ± 9.16 years; and range, 9–73 years) as the control group. Blood samples were obtained from the antecubital vein from all of the volunteers. Albumin cobalt binding test was used to obtain the IMA levels.

Results:

The mean IMA level was 0.38 ± 0.06 absorbance units in the study group at the time of diagnosis, 0.35 ± 0.07 absorbance units at the posttreatment period, and 0.35 ± 0.06 absorbance units in the control group. IMA levels of patients in posttreatment period were lower than the onset of illness. The result was statistically significant (P = 0.01).

Conclusion:

The data demonstrate that IMA decreased in BP with treatment. This is a preliminary study and we could not obtain results that clearly support the ischemic hypothesis of pathogenesis of BP; we think it gives an idea for further studies.
Clinical Implications of Culture and Sensitivity Data in Chronic Otitis Media
Authors: Gangwar Navneeta , Siddapur Geetha Kishan , Sharma Shalaka
Published: May 2024

Context:

Persistent ear discharge in chronic otitis media leads to various complications, hearing loss, and is a hindrance in the successful surgical management of the patients. Recent and updated culture and sensitivity data are an imperative tool in achieving this goal. Empirical antibiotics lead to the development of resistant organisms.

Aims:

This study aimed to identify the most common organisms in chronic otitis media and to study the current sensitivity and resistance patterns to the antibiotics.

Settings and Design:

This was a retrospective descriptive study

. Subjects and Methods:

Retrospective data were collected for patients visiting the outpatient department of the department of otorhinolaryngology from May 2019 to September 2020, who underwent culture and sensitivity for ear discharge.

Results:

Pseudomonas aeruginosa was the most common organism isolated (54.6%) and showed the highest sensitivity toward piperacillin/tazobactam and polymyxin-B (96.4%). Staphylococcus aureus was the second most common organism which showed the highest sensitivity toward linezolid and teicoplanin (100%). Both Pseudomonas and S. aureus showed the lowest sensitivity toward ciprofloxacin. The incidence of multidrug resistance organisms was 46%. All Methicillin-resistant S. aureus (MRSA) were resistant to ciprofloxacin.

Conclusion:

The study data indicate a shift in the antibiotic sensitivity patterns of the organisms. Due to the high resistance pattern, ciprofloxacin should be avoided in empirical treatment regimens. Culture and sensitivity should be made mandatory for all ear discharges and we should have antibiotic protocols based on recent culture and sensitivity data.
The hand that wears cane can also garland: Reminiscences from Dr SP Dey’s life
Authors: Nayak Chaturbhuja
Published: May 2024

Abstract

Dr. SP Dey was a gigantic personality in the field of Homoeopathy. He was well-known as an eminent teacher, a very reputed clinician in the domain of classical homoeopathy, an outstanding author, and a popular speaker of his time. His deliberations on homoeopathic philosophy, blended with profound knowledge of Practice of Medicine, Materia Medica, and Chronic miasms, brought him to prominence at national and international levels, as a frontline professional.
Tent screws: Predictable guided bone regeneration
Authors: Durrani Farhan , Singh Preeti , Pandey Aishwarya , Tripathi Kaushal Pati , Vishnu J. P. , Imran Fouzia , Taslim Aabida
Published: May 2024

Bone regeneration of large maxillary and mandibular alveolar ridge defects is clinically challenging. Various techniques have been described for the reconstruction of these deficiencies before implant placement. The tent screw-pole technique is one of the effective methods available for clinicians to perform the predictable functional and esthetic reconstruction. The aim of this prospective report was to evaluate clinical and three-dimensional radiographic analyses of two patients treated with xenograft and particulate autogenous bone using tenting screws for regeneration of compromised partial edentulous ridges.
Alcohol Septal Ablation for Hypertrophic Cardiomyopathy Guided by Intracoronary Myocardial Contrast Echocardiography to Reduce Myocardial Damage
Authors: Chien Shao-Fu , Chin Chih-Hui
Published: May 2024

Septal reduction therapy (SRT) is indicated for drug-refractory hypertrophic obstructive cardiomyopathy (HOCM). SRT includes surgical myectomy and alcohol septal ablation (ASA). The outcome between SRTs are similar except complete atrioventricular (AV) block. Intracoronary myocardial contrast echocardiography is used to minimize myocardial damage by ASA. We report a case of 40-year-old male who was diagnosed of HOCM with progressed symptoms under optimal medication. Echocardiography revealed peak velocity cross left ventricular outflow tract (LVOT) 5.3 m/s, systolic anterior motion (SAM) of mitral valve with eccentric mitral regurgitation (MR) and interventricular septal thickness 16 mm. Alcohol (99.5%) 1.5 mL was injected into the first small branch of the first septal artery, under precise localization by intracoronary myocardial contrast echocardiography. The pressure gradient of apex-LVOT-aorta reduced from 90 to 20 mmHg after ASA. No AV block was noted after the procedure and echocardiography revealed improved peak velocity cross LVOT and interventricular septal thickness. No more SAM or eccentric MR was observed. Previous studies recommended ASA reserved for patients with higher surgical risk and severe comorbidities. However, a recent study showed that young adults had better long-term survival and only one-half pacemaker implantation rate than older group following ASA. Under the guidance of intracoronary myocardial contrast, target vessel could be precisely localized to small branch from a septal artery to decrease myocardial damage. Therefore, ASA may be considered as the first-line SRT for symptomatic HOCM due to minimal invasiveness and effective outcome.
Perianal Angioleiomyoma: A Case Report and Review of the Literature
Authors: Gkegkes Ioannis D. , Milionis Vassilis , Goutas Nikolaos , Stamatiadis Apostolos P.
Published: May 2024

Angioleiomyomas are rare benign tumors, which take origin from smooth muscle fibers of the tunica media of veins. Even though angioleiomyomas can appear anywhere in the body, these masses are rarely occurred in the gastrointestinal system. This is the first reported case of perianal angioleiomyomas, where the tumor in close relation with the anal canal was investigated with endoanal ultrasonography. Local excision of such lesion is generally curative.
Global Health Emergency of Monkeypox After COVID-19
Authors: Jain Prachi , Rathee Manu , Shetye Akanksha Gopal , Divakar S. Rajesh , Singh Sandeep , Tomar Sarthak Singh
Published: May 2024

Global hit by coronavirus is followed by another public health emergency known as monkeypox (MPX) that is a rare disease and yet has presented with sudden and wide geographic distribution. The guidelines have been released by the concerned authorities for prevention and management; however, strict measures need to be enforced so that these guidelines can be followed. Surveillance, intervention, close monitoring of the situation, and collaborative international efforts as per the guidelines can optimally aid in achieving the goal of curbing the infection spread. This article presents the current situation update of MPX infection globally and discusses the symptoms, management, and preventive measures to be followed for MPX infection.
Fetal Malformation Anencephaly with Placenta Accreta Spectrum (Increta)
Authors: Lata Indu , Gupta Ruchi , Gupta Amrit , Prasad Pallavi
Published: May 2024

Placenta accreta spectrum (PAS) disorders (accreta, increta, and percreta) are rare but are potentially life-threatening obstetric conditions of high maternal and fetal or neonatal morbidity and mortality. In the patient at risk for accreta, obstetrical ultrasonography should be performed and it can be complemented with magnetic resonance imaging. In suspected cases, a multidisciplinary team with clinical expertise should be involved. Anencephaly is a major lethal fetal anomaly of severe central nervous system malformation and the most common type of neural tube defect (NTD). Although the etiology of anencephaly remains unclear, various maternal-related environmental and genetic risk factors have been reported. Termination of pregnancy is offered for all prenatally diagnosed cases. We are presenting management of the rare case of a pregnant woman having placenta increta with fetal NTD malformation in the form of anencephaly.
COVID-19-Associated Rhino-Mucormycosis and Pulmonary Aspergillosis Infection
Authors: Singh Jitender , Sharma Tarika
Published: May 2024

In the current pandemic, the incidence of fungal infections-associated COVID-19 is surging. Diabetes mellitus, overzealous steroid, and antibiotic use for COVID-19 management may cause or exacerbate the fungal disease. In paranasal sinus (PNS), ethmoids followed by the maxillary sinus are commonly involved with the risk of intra-orbital or/and intracranial involvement is quite common. In lungs, COVID-19 infection has higher mortality rate, if there is an associated fungal infection. Aspergillus fumigates is the most common fungus that cause lung infection and present as discrete lesion different from COVID-19 manifestation. Two cases of COVID-associated fungal infections, i.e., rhino-mucormycosis and pulmonary aspergillosis are described here. In the first case, computed tomography (CT) of PNS was done for the complaints of mild right-sided facial swelling and mild restriction of the eye globe on day 27 of illness. CT showed hyperdense content involving the right-sided nasal sinus with the remodeling of bones with erosion and thinning of the inferior and medial orbital wall with the extension of soft tissue into the extraorbital space. The patient was treated with Amphotericin B and posaconazole oral suspension as the first-line antifungal monotherapy. In the second case, on complaints of cough with expectoration on the 20th day of illness, X-ray chest and CT chest were done which confirmed a thick-walled cavity in the right lung and other post COVID features. The tracheal aspirate culture was suggestive of Aspergillus fumigatus and Aspergillus antigen galactomannan was found positive in the fluid. The patient was treated for the same with antifungal therapy. Hence it is important to pay attention to the high probability of fungal infections in COVID-19 patients. The association of coronavirus with mucormycosis of the PNSs and aspergillosis of the lung must be given outmost consideration. Noncontrast CT of the PNSs is usually the first investigation of choice for PNS involvement, and CT chest help in the diagnosis of pulmonary fungal infection. Uncontrolled diabetes and use of steroids are two of the main factors for aggravating factors. Both early surgical intervention and anti-fungal treatment should be sought for the management.