Atypical Facial Chondroid Syringoma, A Rare Clinical Entity: Case Report with Review of Literature.

Chondroid syringoma (CS) is a rare mixed tumor of sweat gland origin with a reported incidence of less than 0.1%. The tumor is mostly benign and usually seen in males. It comprises of both epithelial and mesenchymal elements. The usual presentation and clinical course of this condition makes it liable to be confused with other commoner skin conditions. We hereby present a case of facial CS in a young female patient.

Effect of autologous PRP on wound healing in dental regenerative surgeries and its correlation with PDGF levels.

INTRODUCTION: Autologous platelet-rich plasma (PRP) is the fraction of blood plasma, with increased concentration of platelets, from baseline serum level. Growth factors (GFs) in PRP expedite the soft tissue and bony healing. However, estimation of their levels and role in healing had not been studied extensively. This study gives an insight to the quantification of platelet-derived GF-BB (PDGF-BB) present in PRP and its correlation with the clinical wound healing and bone regeneration. AIMS: This study aims to quantify PDGF-BB levels in PRP with its subsequent correlation with healing in dental regenerative surgeries. SETTINGS AND DESIGN: This was an experimental study including patients undergoing various dental regenerative surgeries. SUBJECTS AND METHODS: Autologous thrombin-activated PRP in the form of PRP gel was used in study group (n = 39) whereas no such intervention was given in control group (n = 30). PDGF-BB quantification was done in PRP samples using enzyme-linked immunosorbent assay. Clinicoradiological evaluation of healing was done in both the groups. STATISTICAL ANALYSIS USED: Descriptive analysis, independent Z-test, Correlation regression analysis, and ANOVA. RESULTS: Mean platelet concentration achieved in PRP was 5.79 times the baseline count. Mean PDGF-BB concentration in PRP was 31.92 ± 10.47 ng/ml which significantly correlated (P < 0.05) with the PRP platelet count. Study group showed significant healing clinically (P < 0.05). Significant bone fill observed in study group at 3 and 6 months when compared to the baseline as well as control group. Furthermore, bone fill at 6 months showed linear correlation with PGDF-BB levels (r = 0. 80). CONCLUSIONS: PRP led to enhanced bone regeneration and soft-tissue healing with former being directly related to higher concentration of PDGF-BB.

Cytological diagnosis of osteoblastoma of the talus: Case report with unusual presentation and diagnostic pitfalls.

Osteoblastoma is a rare bone tumor mostly affecting the young adults and commonly involving the spinal cord and long bones. Talus is the uncommon site of presentation, and if involved, then the neck is more commonly involved than the body of talus. The cytological diagnosis of osteoblastoma is limited, and to the best of our knowledge, its fine-needle aspiration (FNA) in the talus has still not been reported in the literature. The present case of osteoblastoma is, therefore, being reported due to the unusual presentation in elderly male in the body of talus and showing extensive involvement on X-ray. The case was initially diagnosed on FNA cytology excluding the possibility of giant-cell tumor and osteosarcoma. The case also highlights the importance of vigilant observation of subtle cytological features of this rare tumor which may be helpful in avoiding diagnostic pitfalls, especially at an uncommon site and with unusual presentation. An early precise diagnosis by cytology may be followed by appropriate treatment and thus avoiding any further complications.

Primary sinonasal lymphoma in immunocompetent patients: A 10 years retrospective clinicopathological study.

INTRODUCTION: Sinonasal tumors occur in the nasal cavity or paranasal sinuses (PNS). These tumors are rare and lymphomas are even rarer. Lymphoma of the nose and PNS may mimic benign processes and may manifest either in an isolated fashion or in conjunction with systemic diseases. B-cell lymphomas, a more favorable diagnosis, account for the majority of cases, whereas T-cell and extranodal natural killer lymphoma are associated with rapid disease progression and death. MATERIALS AND METHODS: All patients with sinonasal lymphomas who were nonreactive for HIV and were operated and treated in our hospital from 2006 to 2016 were included in the study. Histopathological diagnosis and immunohistochemistry using a panel of antibodies (CK, CD99, CD 15, CD30, CD45, Bcl 2, anaplastic lymphoma kinase-1, CD 16, CD 57 and ki-67) were reviewed and recorded. RESULTS: Out of 153 malignant sinonasal tumors, 18 were diagnosed with lymphoma. Non-Hodgkins lymphoma constituted 88.8% of cases with the most common subtype being diffuse large B-cell lymphoma (n = 12, 66.6%). Maxillary sinus was the most frequently involved site (62%). The average age of presentation was 52 years with a slight male predominance. Computed tomography and magnetic resonance imaging scans were done in virtually all cases to assess the extent of the tumor as well as bony destruction. Average 5-year survival was 50%. Local recurrence was the most frequent cause of treatment failure. CONCLUSION: Malignant lymphomas constituted 11.7% of all malignancies of PNS. The association of diffuse large B-cell tumors with obstructive nasal mass and T-cell tumors with septal perforation, orbital extension and ophthalmological symptoms were more commonly seen.

Human immunodeficiency virus/acquired immune deficiency syndrome: A survey on the knowledge, attitude, and practice among medical professionals at a tertiary health-care institution in Uttarakhand, India.

INTRODUCTION: Health-care professionals are trained health-care providers who occupy a potential vanguard position in human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) prevention programs and the management of AIDS patients. This study was performed to assess HIV/AIDS-related knowledge, attitude, and practice (KAP) and perceptions among health-care professionals at a tertiary health-care institution in Uttarakhand, India, and to identify the target group where more education on HIV is needed. MATERIALS AND METHODS: A cross-sectional KAP survey was conducted among five groups comprising consultants, residents, medical students, laboratory technicians, and nurses. Probability proportional to size sampling was used for generating random samples. Data analysis was performed using charts and tables in Microsoft Excel 2016, and statistical analysis was performed using the Statistical Package for the Social Science software version 20.0. RESULTS: Most participants had incomplete knowledge regarding the various aspects of HIV/AIDS. Attitude in all the study groups was receptive toward people living with HIV/AIDS. Practical application of knowledge was best observed in the clinicians as well as medical students. Poor performance by technicians and nurses was observed in prevention and prophylaxis. All groups were well informed about the National AIDS Control Policy except technicians. CONCLUSION: Poor knowledge about HIV infection, particularly among the young medical students and paramedics, is evidence of the lacunae in the teaching system, which must be kept in mind while formulating teaching programs. As suggested by the respondents, Information Education Communication activities should be improvised making use of print, electronic, and social media along with interactive awareness sessions, regular continuing medical educations, and seminars to ensure good quality of safe modern medical care.

Syringocystadenoma Papilliferum of Sweat Gland of Caruncle: A Unique Case Report.

Syringocystadenoma papilliferum (SP) is a rare benign hamartomatous malformation of skin which arises from apocrine or eccrine sweat glands. Skin of the head and neck is the usual site for this but rarely involves the eyelids. It is also called as a childhood tumor since it usually appears at birth or during puberty. The diagnosis is confirmed on histopathological examination after surgical excision. We are first to report a case of SP involving the caruncle in an elderly female.

Spectrum of Sinonasal Tumors: A 10-year Experience at a Tertiary Care Hospital in North India.

OBJECTIVE: Sinonasal tumors are a highly heterogeneous group of tumors that account for less than 1% of all cancers. Precise diagnosis is essential because the natural history, treatment, and prognosis vary for different neoplasms. We reviewed 610 cases of sinonasal lesions to understand this entity better. METHODS: A total of 610 sinonasal biopsies/specimens were received over a period of 10 years (2004-14). All the samples were processed and stained with hematoxylin and eosin. Special staining for microorganisms and immunohistochemistry were performed where indicated. RESULTS: Benign lesions were 72% with nasal polyp being the most common. Malignant lesions made up 21.2% of lesions with nasopharyngeal carcinoma being the most common while 7.7% cases were inflammatory/non-neoplastic. The most common cause for this was fungal sinusitis. The maxillary sinus was the most frequently involved site in all the lesions (62%). The average age of presentation was 40 years old, and the male to female ratio was 3:1 in those with benign tumors. The average age of presentation in the malignant and inflammatory group were 45 and 43 years, respectively, with an almost equal sex ratio in both categories. Computed tomography and magnetic resonance imaging scans were done in virtually all cases to assess the extent of the tumor as well as bony destruction. Local recurrence was the most frequent cause of treatment failure. CONCLUSION: Tumors of the nasal cavity are often grouped with those in the paranasal sinuses. Benign tumors constituted approximately 75% of tumors in our hospital. Squamous cell carcinoma was the most common malignancy of this region. These tumors need to be studied closely and accurately because their proximity to vital structures pose significant challenges for their treatment and may be the source of significant patient morbidity.

Trichinella spiralis: Mere Co-Existence or Carcinogenic Parasite For Oral Squamous Cell Carcinoma?

Trichinella spiralis is a parasite which is usually seen in pork-eaters. Most of the trichinosis infections cause little or no symptoms. We report a rare case of a middle aged North Indian male who presented with a painless ulcer in right buccal mucosa which was biopsied and reported as squamous cell carcinoma. Wide local excision was done subsequently which showed encysted larvae of Trichinella spiralis in the deeper skeletal muscle bundles. This article supports the carcinogenic potential of trichinosis and suggests timely work-up and treatment of the parasite.

Pigmented Pre-malignant and Malignant Lesions of Skin with Special Reference to Atypical Presentations.

BACKGROUND: Cutaneous melanocytic proliferations are diverse both morphologically as well as in their behavioural patterns. Both dermatologists and pathologists regularly encounter diagnostic dilemmas while interpreting such lesions. AIM: To study all cutaneous premalignant and malignant lesions with respect to their clinical features and histopathological findings. MATERIALS AND METHODS: A retrospective study was done in the Department of Pathology over a period of 10 years (2004-14) on all the clinically pigmented lesions that were biopsied or excised. Out of these only premalignant and malignant melanocytic lesions were analysed with respect to their important clinical and histologic features. Immunohistochemistry was carried out using HMB-45 and S-100 where indicated. RESULTS: A total of 338 skin cancers were reported, out of these 27, 7.9% were cutaneous malignant melanoma. Premalignant lesions were 33. The mean age for premalignant lesions and melanomas was 43 years and 50.7 years respectively with a male predominance in both groups. The sole of foot/ankle was the most common site of involvement by melanoma (n=8,29.6%) while sun exposed sites like face and scalp were common sites for development of premalignant lesions like dysplastic nevi, lentigo simplex, pigmented seborrheic keratosis and Bowens disease. One case presented as post-traumatic scar tissue which turned out to be desmoplastic melanoma. One case of amelanotic melanoma presented as recurrent painful penile ulcers. Both cases were confirmed on Immunohistochemistry. CONCLUSION: All pigmented lesions should be regarded as tumours of uncertain malignant potential and treated with complete excision if possible with long term follow up.

Implementation of an education development project in pathology to improve student competency-lessons learnt.

CONTEXT: Basic medical sciences and clinical teachings are not coordinated in the present medical education system. They are not taught keeping in mind the outcomes required at the time of actual handling of patients in the community. AIMS: An educational development project was implemented in the Department of Pathology with the aim that it will result in the student learning to link the pathophysiology of the disease to clinical scenarios and become fully competent for lifelong medical practice. SUBJECTS AND METHODS: The pathology teaching of the second professional batch was modified by starting with defining the desired outcomes/competencies in the student's knowledge, skills, and attitude which were then addressed by lectures, demonstrations, practical classes and small group activities where case scenarios and laboratory reports were included. The outcome was assessed by Objectively Structured Clinical/Practical Examination and multiple choice questions. Force field analysis, faculty and student interviews, and questionnaires were used to assess the factors affecting its implementation and impact. RESULTS: Totally 80 students of the 2(nd) Professional MBBS were exposed to a competency-based education development project. It was found that the system was appreciated by faculty and students, especially the integration with clinical scenarios. There were many factors which influenced the execution of this program, including motivation level of students and faculty, time, logistics and meticulous planning. CONCLUSIONS: There was a significant improvement in student's performance and satisfaction. Many factors including prior planning were a major determinant for the success of this education development project.

Therapeutic platelet reduction: Use in postsplenectomy thrombocytosis.

Therapeutic platelet reduction is an effective modality for the reduction of platelet count in patients with treatment of extreme thrombocytosis resulting from a variety of primary and secondary causes of thrombocytosis, which may be associated with thrombotic or hemorrhagic complications of varying degrees. These cases when symptomatic fall into the ASFA Category II indication for therapeutic platelet apheresis procedure. Here, we report a case of postsplenectomy secondary thrombocytosis presenting with extremely high platelet counts and subsequent thrombosis in the shunt and successful treatment after therapeutic platelet reduction. The case is being presented to bring forth the fact that therapeutic platelet reduction is an easy procedure that gives quick and good results and also to bring to the attention of transfusion specialists an associated but as yet unreported procedural finding.

Mesenchymal chondrosarcoma of the mandible: a rare malignant tumor.

Mesenchymal chondrosarcoma (MCHS) is a highly aggressive, malignant, cartilaginous tumor that represents about 1% of all chondrosarcomas. Only about 50 cases of MCHS of the jaw have been reported in the English-language literature; maxillary tumors are much more common than mandibular tumors. We present a new case of MCHS of the mandible that arose in a 22-year-old woman whose initial two biopsies did not reveal the features of the tumor. The diagnosis was made only after an incisional biopsy.

Osteolytic lesions of hand and feet: a seven-year experience from a tertiary referral centre of North India.

There are 106 bones in hands and feet but their lesions are not commonly reported. This was a retrospective study of all osteolytic lesions involving bones of the hands or feet presenting to the only tertiary referral centre of the north Indian state of Uttarakhand during the 7-year period from January 2006 to December 2012. A compilation of the various demographic, clinical, radiological and histopathological findings was made. Of the 52 lesions encountered in the 7-year record, 75% were asymptomatic. 20 (38.4%) were benign tumours, 20 (38.4%) tumour-like lesions, 9 (17.3%) inflammatory and post traumatic lesions and only 3 (5.7%) were malignant lesions. Giant cell tumour was the most common benign tumour, aneurysmal bone cyst the most common tumour-like lesion and non-specific osteomyelitis was the most common inflammatory and post-traumatic pathology. All phalangeal lesions were non-malignant and 62% were either giant cell tumours or giant cell reactions. Giant cell reaction was confined to upper limb bones; metatarsals were afflicted exclusively with giant cell tumours (n=3) while malignant lesions affected the metacarpals in two and carpal bones in one instance. Aneurysmal bone cysts were seen exclusively in the tarsal (n=4) and carpal bones (n=2), a very rare finding. More cases need to be studied to define patterns of lesions of hands and feet. The definitive diagnosis is essential as many patients with osteolytic lesions may not require surgical intervention.

Clinical profile of pharyngeal malignancy in a tertiary care centre, state of uttarakhand.

Pharynx is a common site of malignancy in the head and neck region. This study presents a series of 94 cases of pharyngeal malignancy conducted at Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand in the Department of Otorhinolaryngology for a period of one year (2009-2010). Mean age at presentation was 56.8 years (age range 18-100 years). Male:Female ratio was 8.4:1.0. Maximum patients belonged to lower socio-economic status as per Kuppuswamy's classification (2003). Majority of them were farmer (38.2%) by occupation and belonged to rural areas. 90.4% patients had history of tobacco smoking. Dysphagia was the commonest chief complaint. The most common subsite was oropharynx (51.0%) followed by hypopharynx (45.7%). Ulceroproliferative growth was the most common clinical finding. Histopathologically, squamous cell carcinoma (94.6%) was the commonest. CECT was the commonest and most useful radiological investigation done to see the extent of the disease.

Is ectopic pregnancy possible after hysterectomy?

OBJECTIVE: To determine whether ectopic pregnancy should be suspected in young women with abdominal pain even after hysterectomy. DESIGN: Case report. SETTING: The patient presenting with abdominal pain in the emergency department was referred to a tertiary care center. PATIENT(S): A young woman who had had a subtotal hysterectomy 3 years prior for atonic postpartum hemorrhage during her last caesarean section presented with acute abdominal pain. INTERVENTION(S): Urgent ultrasound showed a gestational sac of 9 weeks + 3 days. Emergency laparotomy was done for suspected ectopic pregnancy. MAIN OUTCOME MEASURE(S): Ultrasound, operative findings, and histopathology. RESULT(S): Tubal ectopic pregnancy was confirmed on laparotomy and histopathology. CONCLUSION(S): Early suspicion can avoid missing early and treatable ectopic gestation before life-threatening complications develop.

Giant benign nodular hidradenoma of the shoulder: A rare tumor in orthopedic practice.

A clear cell hidradenoma is a rare dermal tumor, which is believed to originate from the apical portion of the sweat glands. The usual size reported is 5-30 mm. It is generally found in the head, face, and upper extremity regions. This lesion has not been reported to be large enough to impinge a joint range of motion. Hence, its description in the orthopedic literature is extremely rare. We present a giant benign nodular hidradenoma presenting as painful restriction of the right shoulder joint in a 35-year-old male.

An unusual presentation of Aspergillus species in a routine cervicovaginal pap smear: a case report.

BACKGROUND: Finding fruiting bodies and hyphae of Aspergillus species in a routine cervicovaginal Pap smear is a rare occurrence. When encountered, it is important to distinguish between a true infection and contamination. The fruiting body also plays a very important role in distinguishing the various Aspergillus species. CASE: A 52-year-old woman underwent routine gynecologic and Pap smear examination. Her per-vaginal and per-speculum examinations were unremarkable. Pap smear showed atrophic changes with few acute inflammatory cells. However, a large number of hyphae and many fruiting bodies of Aspergillus species were observed in the smears. Close examination of the smear and clinical investigation indicated that the presence of Aspergillus species was due to contamination. Clinical follow-up with repeat Pap smear after I month was unremarkable. CONCLUSION: Fruiting bodies and hyphae of Aspergillus are rare in routine Pap smears. If seen, a differentiation between a true infection and contamination becomes mandatory. The fruiting bodies and hyphae provide an important clue to diagnosis of particular Aspergillus species and differentiating from other similar fungi. A contaminated smear overrules the toxic antifungal therapy and undue follow-up, whereas true infection requires careful study of immune status and prompt investigation.

Pattern of cancers amongst patients attending Himalayan Institute of Medical Sciences, Dehradun.

This hospital-based study seeks to find out the most common cancers amongst the patients attending Himalayan Institute of Medical Sciences (HIMS), Dehradun, situated in Uttaranchal, which has inadequate health care facilities and low socio-economical status. In our study, of the 20,247 cases reported in the pathology department from July 1996 to Dec. 2003, 18.57% cases were malignant. Male to female ratio was 1.7:1.Top five cancers in males were those of lung, larynx, non-Hodgkins lymphoma, oesophagus & stomach. Top five cancers in females were those of breast, cervix, gall bladder, ovary & oesophagus. Tobacco and alcohol related cancers predominated in males. Skin and soft tissue cancers and were also common amongst both genders. Patients mostly reported with cancers in advanced stages, which could be attributed to poor medical facilities and health awareness in this region.