bluuebunny/crossref_metadata_2025 huggingface dataset:
Thigh mass in a patient with malignant pleural mesothelioma
Authors: Sunitha S. , Shah Ashini H. , Gami Amisha , Trivedi Priti
Published: May 2024

Soft tissue tumors are a highly heterogeneous group of lesions with varied clinical presentation. The majority is primary tumors and metastatic tumors are very rare. Malignant pleural mesothelioma presenting as a soft tissue mass at a distant site is even rarer and can cause diagnostic challenges both clinically and pathologically. We report a case of malignant pleural mesothelioma presenting as a soft tissue mass in the left thigh. A 59-year-old man, non-smoker, working in a cement factory since 30 years presented with complains of difficulty in walking since 1½ months. Review of his previous medical records revealed malignant pleural mesothelioma, which was diagnosed 9 months before. He had denied chemotherapy and was on Ayurvedic medication. The lesion involved the adjacent intercostal muscles. Few enlarged lymph nodes were noted in mediastinal and cervical regions. Biopsy of left supraclavicular and right cervical lymph nodes showed metastases. Metastasis from malignant pleural mesothelioma to the thigh was confirmed by immunohistochemistry. The tumor was positive for CK5/6, CK7, Calretinin and vimentin and immunonegative for CEA, Napsin A and TTF 1.
Gastric glomus tumor
Authors: Vyawahare Manoj A , Musthyala Bharati N , Tayade Ramakant T
Published: May 2024

The glomus tumor of stomach is an unusual submucosal mesenchymal tumor of the gastrointestinal tract. We describe a 42-year-old female who presented with chronic anemia and an episode of painless hematemesis. A preoperative diagnosis of the probable gastric gastrointestinal stromal tumor was made. Post-surgical histopathological examination of the specimen demonstrated a glomus tumor of the stomach confirmed on immunohistochemistry. The present case highlights the importance of morphology and immunohistochemistry in differentiating the subepithelial tumors of the stomach and one must consider glomus tumor in differential diagnosis of these gastric lesions.
Plexiform fibromyxoma of the stomach
Authors: Goyal Surbhi , Beso Patricia , Khullar Rahul , Sakhuja Puja
Published: May 2024

Plexiform fibromyxoma (PF) is a recently described rare type of mesenchymal tumor of the stomach with only 123 cases reported in the literature. It is characterized by a peculiar plexiform growth pattern, myxoid stroma with arborizing microvasculature, and spindle-shaped myofibroblastic cells. We herein report a case of gastric PF in a 15-year-old boy, mimicking a gastrointestinal stromal tumor (GIST) due to overlapping clinicoradiological features. Distinct pathological and immunohistochemical features of PF do aid in distinction from GIST and other mesenchymal entities. Diagnosis is crucial as surgical resection is the mainstay of treatment unlike aggressive management in GIST. It is a benign entity with no local recurrence or distant metastasis reported so far, but confirmation of the same requires longitudinal observational studies with a larger sample size.
Serum CA 19-9 and CA 125 as a diagnostic marker in carcinoma of gallbladder
Authors: Bind Manoj K. , Mishra Ravi R. , Kumar Varsha , Misra Vatsala , Singh Premala A.
Published: May 2024

Background:

Gall bladder carcinoma is endemic in North India along the Ganges belt. Most of the cases usually present in late stage when prognosis is poor. That mandates a necessity for proper screening in these areas for gall bladder lesions. Tumor markers CA 19-9 and CA 125 have been studied in various GI cancers and may also help in the screening, diagnosis and evaluation of gall bladder carcinoma. Aims: To assess serum CA19-9 and serum CA125 in patients with gall bladder lesions and find out a cut off value for diagnosis of carcinoma gallbladder.

Methods and Material:

Study included 118 cases, with female: male ratio of 4:1. Out of it, 91 (77 %) cases were benign and 27 (23 %) were malignant. Patients' sera was collected and analyzed for CA19-9 and CA 125 by CMIA method.

Results:

The Mean (SD) value of CA19-9 for benign and malignant cases was found to be 12.86 (17.54) and 625.35(186.52) U/ml. For CA 125 it was found to be 17.98(13.69) and 239.63(73.72) U/ml respectively. The difference was statistically significant (P< 0.001). When Mean - 2SD value of malignant lesions were taken as cut off a value of CA 19-9 and CA 125 were found be 252.31 U/ml & 92.19U/ml respectively, found to be significant to suggest /diagnose a case of carcinoma gall bladder along with clinicoradiological findings. Taking these value as cut off Sensitivity & Specificity for CA 19-9 and CA 125 in detecting malignant cases were found to be 100% & 98.90% and 100% & 94.50% respectively.

Conclusions:

It is concluded that both serum CA 19-9 and serum CA 125 may act as a good adjunct for diagnosis of cases of carcinoma gallbladder along with imaging studies. However, changes in CA19-9 are more significant than CA 125.
Multilocular cystic renal oncocytoma—Awareness of an unusual morphologic variation
Authors: Jagdale Rakhi V. , Pol Jaydeep N.
Published: May 2024

Background:

Renal oncocytomas are benign epithelial tumors usually detected incidentally. They are typically solid, well-circumscribed, homogenous, mahoganybrown with a central stellate scar. Sometimes, they can have cystic degenerationand rarely present as a multilocular cyst which can be mistaken for other cystic renal carcinomas.

Methods:

We describe a case of incidentally detected multilocular cystic renal oncocytoma having an unusual gross appearance of multiloculation with perinephric fat invasion. The tumor exhibited tubulocystic architecture posed a diagnostic dilemma. Detailed study of multiple sections coupled with immunohisto chemistry helped elucidate the diagnosis. Till date, only eight cases of multicystic renal oncocytoma have been reported in the English literature.

Conclusions:

We emphasize the importance of awareness of this unusual morphologic variation to ensure correct diagnosis.
COVID-19-associated mucormycosis – ”The Black fungus” with associated invasive aspergillosis and actinomycosis infection: Series of 5 cases in the Indian scenario
Authors: Menia Reetika , Raychaudhuri Sujata , Agarwal Charu , Taneja Juhi
Published: May 2024

COVID-19 caused by SARS-CoV-2 has been studied and reported widely since November 2019, after its first case was detected in Wuhan, China. It has proven to be a fatal disease worldwide. COVID-19 causes severe disease in patients with immunosuppression and has always been associated with high mortality in such patients. Immunocompromised patients are always at a higher risk of getting co-infections too, and the same is true with COVID-19. It predisposes to the development of many fungal infections of which, mucormycosis is one of the most common ones, especially in the Indian population where a large group of the population is predisposed to diabetes mellitus. India has the world’s largest population of diabetic patients; therefore, the prevalence of COVID-19-associated mucormycosis (CAM) is also the highest in India. Also, the use of corticosteroids over a long duration of time predisposes the patients to the development of mucormycosis owing to immunosuppression. Hypoxia, low total leukocyte count, and high ferritin are the other predisposing factors that lead to the growth of mucormycosis associated with COVID-19. Here, we present five cases within a span of 2 months, of mucormycosis-associated COVID-19 with mixed infections of aspergillosis and actinomycetes. Four cases had mucormycosis with aspergillosis and one with mucormycosis with Actinomyces. Three patients recovered fully after being treated with intravenous amphotericin B; however, unfortunately, two of our patients could not be saved.
Adrenal schwannoma
Authors: Bhattacharya Sumanta , Kumar Ankit , Chatterjee Uttara , Pal Dilip K.
Published: May 2024

WHO classification of adrenal tumors. Only a handful of cases have been reported so far. A 30-year-old lady presented with cerebrovascular accident. CT scans of the abdomen and pelvis revealed a 3.5-cm well-defined, smooth margined, heterogeneously enhancing, mass lesion in the right adrenal gland. She had no endocrine symptoms and urinary metanephnines were normal. She underwent right adrenalectomy for incidentaloma. Histopathology of the excised mass showed features of an adrenal schwannoma. Diagnosis of adrenal schwannoma on imaging studies is difficult preoperatively and raises suspicion of other adrenal tumors. Surgical excision followed by histopathology confirms the diagnosis.
A rare case of primary giant myxoid liposarcoma of the pericardium
Authors: Khandeparkar Siddhi Gaurish Sinai , Kulkarni Maithili Mandar , Mishra Pooja , Patel Ashmira Zainab Mushir
Published: May 2024

Primary pericardial neoplasms account for 6.7–12.8% of all primary tumors arising in the cardiac region. Pericardial tumors are most likely to be metastatic and are an extension of the primary tumors from the surrounding structures. Sarcomas of the pericardium are rare. Myxoid liposarcoma (ML) represents about 5% of all the soft-tissue sarcomas in adults. They are usually located in the deep soft tissues of the extremities. There have been less than 20 cases of pericardial liposarcomas reported on PubMed since 1973. Here, we present a rare case of primary giant pericardial myxoid liposarcoma (ML) in a 46-year-old female diagnosed on frozen section and later was confirmed histopathologically.
The effect of different diagnostic timings and types of placenta accreta on the pregnancy outcome
Authors: Xu Rongli , Cai Lihong , Xu Shuxia , Yan Jianying
Published: May 2024

Objectives:

To explore the effects of maternal and fetal outcomes after different diagnostic timings of placenta accreta and its types.

Methods:

We retrospectively collected the clinical information of 1178 pregnant women with placenta accreta in Fujian Maternity and Children Health Hospital from January 2012 to January 2017. According to the different diagnostic timings of placenta accreta, they were divided into groups of prenatal diagnosis and postpartum diagnosis; and according to the types of placenta accreta, they were divided into groups of accreta group, increta group, and percreta group.

Results:

1. Women with antenatal diagnosis more often had placenta previa and history of previous cesarean section. 2. Women with antenatal diagnosis had a higher rate in blood loss and blood transfusion. 3. The rate of blood loss, blood transfusion, infection, disseminated intravascular coagulation (DIC), secondary laparotomy, hysterectomy had statistically significant differences (P < 0.05) in different types of placenta accreta. The deeper of placenta accreta, the higher the incidence of complications.

Conclusion:

It is important to pay attention for risk factors of the placenta accreta, then improve prenatal diagnostic rate of the placenta accreta and its types, which can forecast the severity of illness to improve maternal and fetal outcomes.
Is immunohistochemistry always the panacea to morphologic mimics? Two, distinct soft tissue tumors exhibiting alveolar pattern and TFE3 immunoreactivity
Authors: Shah Aekta , Rekhi Bharat , Patil Asawari
Published: May 2024

Alveolar soft part sarcoma (ASPS) and certain perivascular epithelioid cell neoplasms (PEComas) exhibit overlapping histopathological features, including immunohistochemical expression of TFE3, as well as TFE3 gene rearrangement. PEComas with an epithelioid morphology are known to exhibit variable immunoexpression of muscle markers. At the same time, aberrant immunoreactivity of HMB45 immunostain, which is invariably, used to substantiate a diagnosis of a PEComa, has been reported in various other tumors. Herein, we discuss two rare cases of soft tissue tumors with overlapping morphological and immunohistochemical features. Case1: A 34-year-old male underwent a biopsy for a recurrent, right-sided nasal polyp. Biopsy showed polygonal tumor cells, containing prominent nucleoli, arranged in a “nesting-type”/alveolar growth pattern. Immunohistochemically, tumor cells displayed TFE3 positivity and an aberrant positivity for HMB45. Special stain (PAS-diastase) highlighted intracytoplasmic granules and crystals. Diagnosis of ASPS was offered. Furthermore, the tumor cells displayed TFE3 gene rearrangement. Case 2: A 29-year-old female underwent an aural polypectomy. Microscopic examination revealed a tumor with a “nesting-type”/alveolar arrangement of tumor cells with vacuolated cytoplasm, arranged around thin-walled blood vessels. Immunohistochemically, tumor cells were diffusely positive for HMB45 and TFE3 and focally for SMA. A diagnosis of a PEComa was offered. This report constitutes the first documentation of aberrant HMB45 immunoreactivity in case of ASPS, and one of the first reported cases of a PEComa in the ear. It emphasizes the value of integrating clinicopathological features with immunohistochemical and molecular results in differentiating two rare, but distinct soft tissue tumors with overlapping features. An exact diagnosis of both these tumor entities has therapeutic implications.
Affiliation and essence of SARS CoV2 (COVID-19) on blood parameters of infected patients
Authors: Karuna Veer , Vivek Vir , Verma Nidhi , Singh Ravinder
Published: May 2024

Background:

Till date, SARS CoV2 (COVID-19) is a pandemic viral infection in the world with the main and strong impact on respiratory airway, but this virus can affect any system of the human body.

Aims:

This research is aimed to dictating the effect of SARS CoV2 infections on hematological, biochemical, and arterial blood gas parameters by using their mean values.

Settings and Design:

This retrospective study was included a total no. of 97 SARS CoV2 positive patients from 27 March to 15 May 2020. All positive patients were consented and took all the significant details.

Materials and Methods:

We review the total 97 COVID-19 positive patients after obtaining all the hematological and other relevant clinical data from laboratory and medical records. The subjects were tabulated into three categories named; admitted (Gp A), discharged (Gp B), and expired (Gp C) patients and compared their hematological, biochemical parameters, and arterial blood gas analysis by using blood or serum and processed by proper methods.

Statistical Analysis:

The data was cleaned, edited, checked for completeness, and processed then entered in SPSS version 20 statistical software.

Results:

Blood samples were collected of all positive patients. Most of the patients had X-ray changes. Blood parameters showed that patients who were expired (Gp-C) suffered from anemia, lymphopenia, leucoytosis, neutrophilia, and thrombocytopenia with high ALT, pCO2 and low pO2 than admitted and expelled patients.

Conclusions:

Result from this study provides that WBC count, absolute lymphocyte count, neutrophil count, and pO2 were independently associated and an important forecaster of mortality from SARS CoV2. All healthcare provides to regularly monitor above parameters indicators of COVID-19 infected patients to improve their quality of life and to reduce the risk of mortality rate.
Comparison of pathological response of standard chemoradiotherapy versus short course radiotherapy in rectal carcinoma: A pilot study
Authors: Nagarjun Bangalore Rammohan , Shah Ashini , Gami Amisha , Gandhi Jahnavi , Parikh Ankita , Modi Viraj
Published: May 2024

Introduction:

Neoadjuvant chemoradiation (CRT) is standard of care for locally advanced rectal cancer. However short course radiotherapy (SCRT) was developed for the benefit of a shorter treatment duration and early surgical intervention which also helped in reducing the case burden to the hospital. SCRT is routinely practised in European countries, Indian experience with the SCRT is limited and hence a pilot study was conducted to compare the morphological difference and pathological response between SCRT and CRT.

Objectives:

A) Evaluate the morphological changes and pathological response between SCRT and CRT. B) Compare the pathologic response with outcome between SCRT and CRT. Materials and Methods: All rectal cancer patients in clinical stage II and III diagnosed during 2016 to 2020, who underwent SCRT or CRT were selected. Altered histopathologic findings due to therapy such as tumor cell morphology, necrosis and stromal response along with pathological response between the study groups were compared along with the outcome.

Results: Ten (12.6%) patients were subjected to SCRT and 69 (87.4%) patients underwent CRT. Morphological changes such as necrosis was noted in nine (90%) and eight (11.5%) cases in SCRT and CRT group respectively. Pathologic complete response (pCR) was noted in 12 (17.5%) cases of CRT only. Near complete response was seen in one (10%) and 14 (20.5%) cases of SCRT and CRT respectively. Despite lower rates of pCR in SCRT, no difference in survival or outcome was noted between the two study groups.

Conclusion:

pCR as expected is less in patients who received SCRT, despite this the outcome during follow up was similar in both the groups. Indian data is very limited and large multi-centre studies should be carried as SCRT offers an advantage of early definitive surgical intervention in addition to shorter duration of hospitalisation when compared with CRT.
Desmoplastic small round cell tumor of the ovary
Authors: Phulware Ravi Hari , Roy Maitrayee , Singh Neeta , Kumar Sunesh , Mathur Sandeep R.
Published: May 2024

Desmoplastic small round cell tumor (DSRCT) is a rare, aggressive neoplasm of uncertain histogenesis that preferentially involves the abdominal and pelvic cavities. DSRCT mainly develops in adolescent and young adults with a strong male predominance; the male to female ratio is 4:1. Ovarian location is exceptional. DSRCT generally develops in the abdomen and have a tendency towards peritoneal spread, with subsequent metastasis to distant lymph nodes, liver and lungs. It is a poorly understood malignancy with a very characteristic morphology, immunophenotype, cytogenetic features, and poor prognosis. This tumor can co-express epithelial, neuronal, and mesenchymal markers. Despite intensive therapy, including surgery, radiotherapy and chemotherapy, and immunotherapy; the 5-year survival is less than 15%.
Isolation and morphology of circulating tumor cells by cell block technique in breast cancer
Authors: Agrawal Nandini , Punia Rajpal S. , Handa Uma , Attri Ashok K.
Published: May 2024

Background:

Circulating tumor cells (CTCs) are cells present in the blood stream that are antigenically or genetically similar to a specific tumor type and are markers of tumor diagnosis, prognosis, residual disease and metastasis. The ever-increasing burden of breast cancer globally warrants the incorporation of this all-inclusive marker in the diagnostic repertoire using the simplest of techniques.

Aims:

To identify CTCs in peripheral blood by cell block (CB) technique in cases of breast cancer diagnosed on fine-needle aspiration (FNA) or core needle biopsy (CNB) and to correlate their presence with nodal metastasis.

Material and Methods:

This study was conducted in the Department of Pathology, at a tertiary care hospital. Peripheral blood samples from a total of 30 cases of primary breast carcinoma diagnosed on FNA or CNB without prior neoadjuvant chemotherapy were analyzed using the CB technique.

Results:

The age ranged between 29-74 years with the most common presenting complaint being a palpable, single, unilateral breast lump. CTCs were detected in 2 (6.7%) cases with a <5 cell cluster with both the cases being grade I breast carcinomas and also displaying nodal metastasis.
Chromophobe renal cell carcinoma with massive sarcomatoid differentiation
Authors: Neagu Anca-Iulia , Neagu Marius , Stefanopol Ioana Anca , Nechita Aurel
Published: May 2024

Chromophobe renal cell carcinoma (CRCC) is a distinct subtype of renal cell carcinoma with unique histological, immunohistochemical, cytogenetic, and ultrastructural features, which usually has a favorable clinical course, with only a small percentage of patients developing recurrence, metastasis, or death due to its complications. Sarcomatoid differentiation can occur in any subtype of renal cell carcinoma and currently represents the transformation into a higher degree of malignancy, its presence being associated with a reserved prognosis, with a reported incidence of average survival of less than 1 year after diagnosis. In this study, we present an unusual case of CRCC with massive sarcomatoid differentiation, which infiltrated the left adrenal gland and was surgically resected. The histological features of this tumor as well as a brief review of literature are presented.
Fibroblast growth factor receptor 1 protein (FGFR1) as potential prognostic and predictive marker in patients with luminal B breast cancers overexpressing human epidermal receptor 2 protein (HER2)
Authors: Amina Belhadj , Lynda Addou Klouche , Sonia Seddiki , Adel Belhadj , Jelloul Benammar H. , Miloud Medjamia , Tewfik Sahraoui
Published: May 2024

Context:

Breast cancer is the most common cause of cancer mortality among women worldwide. It is a heterogeneous disease partly responsible for treatment failure in luminal B patients. Deregulation of fibroblast growth factor signaling has been found and its therapeutic/prognostic value is explored.

Aims:

Most of the research has studied the FGFR1 gene while our study explored its protein expression by immunohistochemestry and examined the association with clinicopathological features, different molecular subtypes and survival.

Subjects and Methods:

Formalin-fixed and paraffin-embedded samples of invasive breast carcinomas were used to analyze FGFR1 expression. FGFR 1 was scored by percentage and intensity of cell cytoplasm staining, correlations were investigated and survival curves were constructed.

Statistical Analysis Used:

Chi-square test was used to assess the relationship between the marker expression and the clinicopathological characteristics. Overall specific survival curves were estimated using the Kaplan-Meier method and statistical significance was assessed using the log-rank test.

Results:

FGFR1 was associated at different staining threshold cut-offs with tumor size (P = 0.002), infiltrating lymph node (P = 0.022), distant metastasis (P = 0.003), positive estrogen receptor (P = 0.000), HER2 overexpression (P = 0.044) and luminal phenotypes (P = 0.026). The results also emphasize FGFR1 correlation expression with distant metastasis in luminal B tumors (P = 0.035) but not with luminal A and with overexpressed HER2 protein in both luminal tumors. FGFR1 expression affect luminal B patients survival with poor outcome.

Conclusions:

FGFR1 expression may serve as a prognostic and predictive factor in luminal breast cancers, it can also be considered as a potential therapeutic target in luminal B cases.
Whipple's disease
Authors: Munjal Yogita , Munjal Sachin D. , Tiwari Richa
Published: May 2024

Whipple's disease is a multisystem disorder and responds well to antibiotic therapy if treated timely. It is seen in the fourth to fifth decades of life with a male to female ratio of 10:1. It mainly affects the intestine, the central nervous system, and joints. To the best of our knowledge, we present the first case of duodenal Whipple's disease in an Indian female, who presented with hyperpigmentation and chronic diarrhea with malabsorption. Whipple's disease was diagnosed based on specific upper GI endoscopic and histopathology findings.
Malignant transformation of monostotic fibrous dysplasia into angiosarcoma in the proximal tibia
Authors: Narter Selin , Yalcinkaya Ulviye , Bilgen Muhammet S. , Yazici Zeynep
Published: May 2024

The majority of bone angiosarcomas are primary tumors while secondary angiosarcomas arise after radiation therapy or bone infarctus. This article presents a case of malignant transformation of monostotic fibrous dysplasia into angiosarcoma. An 80-year-old female presented with pain on right cruris. Radiological examination revealed a lesion with lytic areas and destruction of cortical bone on right tibia. Gross and histopathological examination showed two areas with an abrupt transition. The solid component was composed of curved, immature bony trabeculae in a fibroblastic stroma. The other component involved epitheloid cells forming slit-like vascular spaces. The diagnosis of angiosarcoma and fibrous dysplasia was given. Malignant transformation of fibrous dysplasia into angiosarcoma is extremely rare; as this is the sixth case in the existing literature. Prognosis of fibrous dysplasia is generally good and less than 1% of the patients develop a malignant tumor. Therefore, patients with fibrous dysplasia should be offered a life-long follow-up.
Prognostic implications of CD-57 expression in oral squamous cell carcinoma cases
Authors: Kumar Santosh , Chandra Akhilesh , Agrawal Rahul , Singh Priyanka , Pallavi Meetu
Published: May 2024

Natural killer (NK) cells are one of the most important effector T -lymphocytes having antitumor effect. Only a few studies are present in the literature, correlating the expression of cluster of differentiation 57 (CD-57) in NK cells in oral squamous cell carcinoma (OSCC). To analyze the effect of the presence of NK cells in the stroma of OSCC and their effect on the tumor progression and prognosis. A retrospective study was performed over 122 OSCC patients who had undergone surgical treatment between 2014 and 16. Wax blocks were obtained and subjected to immunohistochemical (IHC) analysis for CD-57 expression. Patients were followed up for 3 years and 100 cases were finally included in the study and divided into three groups. The association between variable were studied through the Chi-square test, Kruskal–Wallis test, and Mann–Whitney U test. A total of 91% of cases showed positive staining for CD-57. Maximum positive expression (96.6%) was observed in the patients who were alive and without recurrence (Group-II) as compared to dead patients (Group-I) and in well-differentiated squamous cell carcinoma (WDSCC) cases (96.8%) than in poorly differentiated cases. Also, the mean CD-57 positive cells count was found to be highest in Group-II and WDSCC cases. A significant correlation was observed between CD-57 expression and patients’ health status. As the expression of CD-57 increased in the tumor stroma of OSCC, the chances for the patient to be alive were increased; therefore, it may serve as a good prognostic marker.
Diagnostic value of galactomannan antigen test in serum and bronchoalveolar lavage fluid sample from suspected patients of invasive pulmonary aspergillosis
Authors: Malhotra Shalini , Kumari Renu , Chauhan Ankit Kumar , Bhatia Nirmaljeet Kaur , Kaur Amarjit , Sharma Brijesh , Duggal Nandini
Published: May 2024

Invasive pulmonary aspergillosis (IPA) is mainly caused by Aspergillus fumigatus and other Aspergillus species. Galactomannan (GM) is a polysaccharide antigen that exists primarily in the cell walls of Aspergillus species. GM may be released into the blood and other body fluids even in the early stages of Aspergillus invasion; therefore, detection of the GM antigen level can be useful in making an early diagnosis of IPA.
External Ear Canal Osteoma Presented as Multilobulated Mass with Peripheral Calcifications
Authors: Kailani Abdul Azim Al-Abrar Ahmad , Nik Othman Nik Adilah , Md Daud Mohd Khairi
Published: May 2024

External auditory canal (EAC) osteoma is a slow-growing benign tumor. It appears as a single, pedunculated hyperdense lesion. Most osteomas are asymptomatic and treated conservatively while surgery is reserved for symptomatic osteomas. Surgical excision of EAC osteoma is approached either endoscopically or microscopically by postauricular, endaural, or transcanal approaches depending on the site and size of osteomas. We report a case of external auditory osteoma presented with an atypical finding of multilobulated mass with peripheral calcification on computed tomography scan.
Case Report on Rare Otologic Sequelae of Coronavirus Disease-2019
Authors: Gianchand Shikha , Ali Mustajib , Swami Himanshu
Published: May 2024

Among multiple etiologies of hearing loss, viral infections often goes unnoticed due to flu like symptoms. Otologic dysfunctions have been reported with COVID – 19 infection as well. however, this case report is unique in terms of otologic dysfunction following the COVID illness. This case report is indicative of the intracochlear damage following COVID - 19 illness. So far, there is no reported case of LO following COVID -19 in the literature. This article brings out the first reported case of SNHL due to labyrithnine ossificans following covid-19 infection.
Type 1 Tympanoplasty with and Without Mastoidectomy in Children
Authors: De Almeida Gustavo Antunes , Correia Filipe , Pimentel João , Escada Pedro
Published: May 2024

Objective:

Assessment of the surgical benefit in children of a canal wall up mastoidectomy with Tos Type 1 tympanoplasty over Tos Type 1 tympanoplasty alone in patients with chronic suppurative otitis media (CSupOM) with tympanic membrane (TM) perforation.

Study Design:

Retrospective study.

Setting:

Tertiary care hospital.

Methods:

A retrospective chart review of CSupOM patients younger than 18-years old and admitted for elective tympanoplasty between 2010 and 2013 was conducted. Primary cases of patients submitted to Type 1 tympanoplasty (according to Tos classification 1993) were selected and were divided into two groups: tympanoplasty with canal wall up mastoidectomy and tympanoplasty without mastoidectomy. Surgical success was defined as the presence of an intact TM with no disease recurrence after 2 years of follow-up.

Results:

From a total of 125 ears (88 pediatric patients), 59 were selected according to the inclusion criteria. The mean age of the patients was 12.5 years, with 5.1% being 7 years old or younger, 67.8% between the ages of 8 and 14 years old, and 27.1% from 15 to 18 years old. 67.8% of the patients were boys and 32.2% girls. The overall surgical success rate was 89.8%, with 88.9% in the tympanoplasty group and 90.2% in the tympanoplasty with mastoidectomy group. Audiometric improvement was observed in both groups with a mean gap closure of 14 dB ± 8.4 dB in the tympanoplasty without mastoidectomy group and 12.5 dB ± 9.5 dB in the tympanoplasty with mastoidectomy group.

Conclusion:

Type 1 tympanoplasty is an effective treatment of CSupOM in children. In these cases, performing mastoidectomy at the time of primary Type 1 tympanoplasty is not associated with improved outcomes.
Efficacy of Human Epidermal Growth Factor in the Regeneration of Tympanic Membrane Perforation
Authors: Mohite Anjana A. , Shrestha Bhagyashree , Mane Rajashri S. , Patil Balasaheb C. , Varute Vasundhara P. , Yasatwar Arpita P.
Published: May 2024

Introduction:

Majority of tympanic membrane perforations require myringoplasty for closure. Recently, epidermal growth factor (EGF) has been shown to promote the healing of tympanic membrane perforations.

Aim:

The aim of this study was to find out a simple nonsurgical outpatient procedure to close one-quadrant tympanic membrane perforations that could reduce the hospital stay, medical cost, and morbidity in these patients.

Materials and Methods:

An interventional prospective randomized clinical study was done on 120 patients at our tertiary hospital. The allocation ratio was 3:1. Pure-tone audiometry, otomicroscopy, and otoenodoscopic recording were performed in all eligible patients who consented to take part in the study. Ninety cases received EGF gel application, whereas 30 controls received antibiotic ofloxacin application. Trichloroacetic acid chemical cautery and fibrin glue application were done in patients of both groups.

Results:

The closure rate was 97.7% in the EGF group and 70% in the ofloxacin group. The time taken for closure of perforations was 10 to 14 days in the EGF group and 3–4 weeks in the ofloxacin group. Hearing gain was observed in healed perforations of both groups.

Conclusion:

EGF application enhances the healing effect of one-quadrant nonhealing tympanic membrane perforations. It showed encouraging results and reliable safety in the regeneration of tympanic membrane.

Clinical Significance:

Apart from its use in single quadrant perforation, EGF may be considered for treating residual perforations after failed tympanoplasty.
Concomitant Sigmoid Sinus and Internal Jugular Vein Thrombosis in Acute Mastoiditis with Subperiosteal Abscess
Authors: Cheah Siew Chung , Mohd Saad Mohd Sazafi Bin , Abdullah Asma
Published: May 2024

Acute otitis media is one of the common conditions that we see in practice every day. It could be a simple condition but also may bring more sinister outcome if not properly treated. Cerebral venous sinus thrombosis is one of the rare but dangerous intracranial complications in acute otitis media. Here, we presented a case in a young adolescent who had acute otitis media complicated with subperiosteal abscess, concomitant sigmoid sinus, and internal jugular vein (IJV) thrombosis. To date, many case reports regarding otogenic sigmoid sinus thrombosis have been published, but a case report discussing concomitant sigmoid sinus and IJV thrombosis is very rare.
Evaluation of the Rate of Tympanic Membrane Perforation in Otomycosis
Authors: Teharia Rajendra Kumar , Rathore Vikram Singh
Published: May 2024

Introduction:

Otomycosis (OM) is an external ear infection of fungi and sometimes associated with tympanic membrane perforation (TMP). In this study, we analyzed and discussed the rate of TMP in otomycotic patients with no other associated pathology.

Materials and Methods:

In this prospective observational study, a total of 120 cases of OM were seen from August 2017 to April 2018 and microscopy with local cleaning was done. Fungal material was collected from all patients individually and sent for Gram staining and histopathological confirmation of fungus species and looked for TMP. Topical clotrimazole (1%) drops were given as empirical treatment with weekly microscopy and follow up to 12 weeks.

Results:

Eleven cases (9%) had tympanic perforation at the time of the first examination. In all cases with the TMPs, the causative organism was the Aspergillus species. Persistent TMP was present in 6 cases (5%). A total of three persistent TMPs required surgical intervention after 12 weeks.

Conclusion:

In OM, TMP is not infrequent and it requires careful examination especially under a microscope to identify it.
Waardenburg Syndrome
Authors: Mounji Houda , Benfdil Malika , Lakhdar Youssef , Chehbouni Mohamed , Rochdi Youssef , Nouri Hassan , Raji Abdelaziz
Published: May 2024

Background:

Waardenburg syndrome (WS) is an autosomal dominant inherited genetic condition that manifests with sensorineural deafness and pigmentation defects of the skin, hair, and iris. This genetically and clinically heterogeneous disease accounts for 2% of the congenitally deaf population.

Objectives:

The aim of our study is to determine epidemiological and clinical characteristics of this group to improve the management, especially for the hearing impairment.

Methods:

Seven cases were diagnosed during the examination of children with suspected congenital deafness.

Results:

The age of our children ranged from 1.3 to 5 years, with a median age of 3.6 years, with female predominance; no consanguineous marriage and fetal or perinatal history have been reported; there was family history of premature greying in four cases and deafness in two cases. Two patients had WS Type 1 with a dystopia canthorum, while four cases had WS Type 2. There was one patient with Waardenburg Klein or Shah syndrome. The otoscopy was normal in all children. Evoked auditory potentials, otoacoustic emissions, and tonal audiometry were performed; they had shown a congenital, sensorineural bilateral, and profound hearing loss >100 dB in all cases. All children had received a cochlear implantation followed by speech reeducation. A genetic consultation was carried out for all our children.

Conclusion:

WS is a relatively common genetic cause of sensorineural hearing loss. Early diagnosis and improvement of hearing impairment are most important for psychological and intellectual development of the children with WS.
Preoperative and Intraoperative Evaluation of Round Window Configuration during Cochlear Implant in Children
Authors: Singh Jyoti , Prakash Jayant , Mishra Sarita Kumari , Jha Shruti , Singh Rakesh Kumar
Published: May 2024

Context:

To establish a reliable factor for predicting the anticipated difficulty and adequacy of niche drilling without damaging the intracochlear structures during cochlear implant (CI) surgery.

Aims:

This study aimed to access the correlation of the distance from round window-to-vertical facial canal and round window to pyramid with the visibility of round window intraoperatively.

Settings and Design:

A prospective observational study of CI surgeries was conducted in the E.N.T. Department of Indira Gandhi Institute of Medical Sciences, Patna, from December 2019 to December 2021. The study included 30 children aged <5 years who presented to the E.N.T. OPD with prelingual deafness and were diagnosed with bilateral severe-to-profound hearing loss.

Subjects and Methods:

The preoperative high-resolution computed tomography images in the axial cut bone window setting at round window level were used to calculate the distance of round window-to-vertical facial canal and round window to pyramid on the RadiAnt DICOM Viewer. The intraoperative visibility was assessed through the recordings of the operation.

Statistical Analysis Used:

The data were analyzed using the MS Office 2019 Excel spreadsheet (Microsoft Corp., Redmond, WA, USA) and the program IBM SPSS 28.0.0 (SPSS Inc., Chicago, IL, USA). One-way analysis of variance was used.

Results:

A significant difference existed between round window and vertical facial canal distance measured preoperatively with the three categories of visibility of round window intraoperatively (P = 0.033), but a weak significant difference was found with the distance of round window to the pyramid with the visibility of round window (P > 0.05).

Conclusions:

Preoperative computed tomography measurement of the round window and vertical facial canal is a reliable predictor of a round window configuration that may aid in predicting the round window visibility.
Impact of Duration of Residual Inhibition on Tinnitus Masking in Patients with and without Hearing Impairment
Authors: Chatterjee Indranil , Gore Geeta
Published: May 2024

Introduction:

Residual inhibition (RI) is described as a temporary reduction in the loudness of tinnitus as a result of stimulation from a noise.

Aim:

This study is aimed to determine the efficacy of durational aspects of tinnitus masking on self-reported tinnitus handicapped measures in patients with and without hearing impairment.

Sample Size:

Sixty participants were included and divided into two groups – Group A (mean age 44.7, standard deviation [SD] 12.02) included tinnitus participants with normal hearing and Group B (mean age 43.81, SD 12.79) included participants with hearing impairment.

Methodology:

Audiological evaluation was done after a detailed case history visual analog scale (VAS) and tinnitus handicapped inventory (THI) were used pre- and post-therapy to assess the severity of tinnitus. Tinnitus masking was done at the level MML + 20 dB at matched frequency of the tinnitus. Each group had three subgroups of ten participants for masking duration– 15, 20, and 30 min of RI. The therapy was terminated when the tinnitus disappeared or after 1 month (5 days a week). Statistical analysis was performed using Paired t-test, Independent t-test, and ANOVA.

Results:

There was a significant difference in the effect of tinnitus masking for pre- and post-data among different masking durations measured in VAS and THI irrespective of hearing status. 30-min masking duration can be used as a standardized norm for tinnitus masking.

Conclusion:

Thus, the study provides a structured temporal course for providing tinnitus masking.
Q10 and Tip Frequencies in Individuals with Normal-Hearing Sensitivity and Sensorineural Hearing Loss
Authors: Devi N. , Sreeraj K. , Anuroopa S. , Ankitha S. , Namitha V.
Published: May 2024

Context:

Cochlear plays a major role in providing fine-tuned frequency resolution of the sounds that were perceived. However, in the impaired auditory systems, this frequency resolution is affected, which indirectly leads to distortion in the perception of the sounds. However, the sharpness of tuning of a filter can be obtained from Q10 values and the shift in the tip frequencies of the psychophysical tuning curve can provide an estimate for the frequency resolution of the cochlea.

Aim:

This study aimed to estimate and compare the Q10 values and tip frequency between individuals with normal hearing and hearing loss.

Subjects and Methods:

A total of 92 ears were included for the study which was divided into two groups based on the hearing sensitivity. The psychophysical turning curves were obtained for 500 Hz, 1 kHz, 2 kHz, 4 kHz, and 6 kHz. The data on Q10 and the tip frequencies were statistically analyzed.

Results:

The results reveal that individuals with hearing loss have lesser Q10 values compared to individuals with normal hearing and this increased with increase in the test frequencies. Comparing the shift in the tip frequency between the two groups of individuals, the shift was toward the lower frequency which indicates it is an involvement of the outer hair cells. However, this study was limited only to those with mild flat sensory neural hearing loss.

Conclusion:

It could be concluded that Q10 and tip frequency measurement would be a valid measure for frequency resolution of the cochlea.
The Credibility of a Smartphone-Based Application for use as a Hearing Screening Tool in Underserved Areas
Authors: Chokalingam Satish Kumar , Mathiyalagen Prakash , Colbert Kumaran Ramesh , Vazhumuni Bhanu , Murugesan Sathiyaseelan , Nagarajan Niveda
Published: May 2024

Context:

Hearing loss has been rightly regarded as “invisible disability.” Globally, it is the third largest cause for years lived with disability. It is imperative to detect it early to initiate remedial measures. We intended to find a cheaper, quick, and reliable alternative to the traditional audiological services.

Aims:

The aim of this study was to assess the hearing levels using a self-administered smartphone hearing application and compare these results with pure-tone audiograms performed by an audiologist.

Settings and Design:

This diagnostic study was conducted at a tertiary care hospital in the State of Puducherry, between 2019 and 2021.

Subjects and Methods:

One hundred and nineteen participants were recruited; hearing screening was done using the smartphone application “Hearing Test” followed by pure-tone audiometry.

Statistical Analysis Used:

The results were analyzed for validity and reliability using SPSS software.

Results:

The mean age was 34.23 ± 9.39 years, and 57.1% had ear complaints at presentation. At the level of statistical significance of P = 0.05, no difference was found between the tests. An absolute difference of <6.712 for each frequency was observed with the average difference being 5.18 dB (95% confidence interval 5.65–4.73) with standard deviation of 3.56. The smartphone application demonstrated a sensitivity of 76.26% and a specificity of 98.99%.

Conclusions:

We did not find any significant difference between the application and pure-tone thresholds in any frequency. Thus, the Hearing Test application is a valid screening tool to assess hearing loss early.
Ṭibb Ghayāthiyya of Ḥakīm Shamsuddīn, a Persian manuscript on Unani medicine: A review
Authors: Ahmad Ashfaque
Published: May 2024

Abstract

Ṭibb Ghayāthiyyais an important Unani manuscript on preventive medicine, written in the Persian language by Ḥakīm Shamsuddīn ibn Nūruddīn during 1605–1627 AD. The author has dedicated this manuscript to his benefactor, Mirza Ghayās Baig, the well-known father of the famous queen Noor Jahan (1577–1645 AD), the consort of the Emperor Jahangir (1569–1627), and named it as Risāla Ghayāthiyya as mentioned in the preface of the book. This treatise contains a Muqaddama (Preface), five Maqāla (Discourses), and a Khātima (Conclusion). It is unpublished so far. Due to the importance of this book in Unani medicine, it has been taken as an IMR project at NIIMH for Editing and Translation from Persian into English. This paper sheds light on this rare Persian manuscript of Ṭibb Ghayāthiyya which is a single copy and preserved only in NIIMH, Hyderabad.
Evaluation of anterior tooth–ridge angulation, root position and labial bone perforation using dental cone-beam computed tomography: An observational study
Authors: Kumar Ankit , Medikeri Raghavendra S. , Sutar Ashwini A. , Waingade Manjushri , Lahane Pritee V.
Published: May 2024

Purpose:

The objective of this study was to use cone-beam computed tomography (CBCT) scans to measure and correlate the maxillary and mandibular tooth–ridge angulation (TRA) and labial bone perforation (LBP) in anterior teeth.

Materials and Methods:

A standardized technique was used to orientate Planmeca CBCT images in 140 patients. On the sagittal section, TRA was defined as the angle between the long axis of the tooth and the alveolar housing of the corresponding tooth. The maxillary and mandibular anterior teeth’s sagittal root locations were evaluated. Virtual implant software was used to analyze bone perforations using a predetermined taper implant system.

Results:

A total of 1680 teeth were scanned for this investigation, and 1338 teeth were selected for further analysis. In comparison to the mandible, the maxilla had a greater TRA. LBP was found to be 4.26% (57 teeth) more common in the mandibular arch (n = 39; 68.42 and) than in the maxillary arch (n = 18; 31.58%). When comparing both the sides, there was no significant difference in LBP. There was a significant relationship between TRA and LBP (P < 0.05). There was a significant association between all parameters. There was no statistically significant difference in TRA, sagittal root position (SRP), and LBP between the right and left teeth.

Conclusions:

The SRP type 1 is most typically present in the anterior teeth. The maxillary anterior teeth were placed at a 5°–10° angle, while the mandibular incisors were parallel to the alveolar ridge. The LBP was more characteristically present in the mandibular incisors. SRP and TRA were directly correlated with LBP. Clinically, bone perforations may be reduced using taper implants and abutments with a 5°–10° angle in maxillary anterior teeth, while straight implants are preferred in mandibular anterior teeth, which may be recommended.