Isolated tubercular hypoglossal nerve paralysis.

Hypoglossal nerve palsy is not an uncommon neurological finding but primary nasopharyngeal tuberculosis (TB) presenting as hypoglossal nerve palsy is very rare. A 31-year-old woman presented with headache and progressive tongue deviation towards the right side. Diagnostic nasal endoscopy revealed soft tissue mass lesion on the posterior wall of nasopharynx while MRI revealed isointense tumour in nasopharynx with normal hypoglossal nerve and brain. Histopathological examination found TB. We discuss the clinical challenges and possible pathogenesis of this rare clinical entity.

Collagenous spherulosis: An interesting cytological finding in breast lesion.

Collagenous spherulosis (CS) is a rare and interesting entity associated with benign breast lesions. CS is an incidental finding picked up only on 0.2% of cytology specimen. Typically cytologically of CS of breast consists of central spherical hyaline spherule surrounded by myoepithelial cells. The central hyaline spherule has been found to be basement membrane material histochemically and immunohistochemically. The importance of recognizing CS of breast lies in the fact that similar hyaline globules can occur in adenoid cystic carcinoma of the breast (ACCB). The two lesions need to be differentiated on cytology failing which inappropriate treatment can be given for either of the two lesions. We present here a case of CS associated with benign breast lesion and a case of ACCB to describe their cytological features and key points to differentiate them cytologically.

Cytomorphology of lung metastasis of pure choriocarcinoma of testis in a 58-year-old male.

Choriocarcinoma is malignancy arising from the trophoblastic tissue. Pure choriocarcinoma is rare in testis. Choriocarcinoma of testis is more commonly associated with other germ cell tumors. The usual age of presentation is 2nd-3rd decade. Distant metastasis is known to occur in choriocarcinoma. We present a rare case of testicular pure choriocarcinoma in a male patient. The patient was treated with orchidectomy, lymphadenectomy, and chemotherapy. Three months later the patient presented with hemoptysis and a lung mass. The aspiration cytology of the lung mass revealed metastatic deposits of syncytiotrophoblastic and cytiotrophoblastic cells. We are reporting this case due to its rarity, rare age of presentation, and characteristic cytology at metastatic focus.

Tonsillitis with acute myeloid leukemia: a case series for caution.

Worldwide, tonsillitis is very common. The most common etiology is cross-infection with bacteria and viruses. These cases are managed with antibiotics and anti-inflammatory drugs without any further investigation because the diagnosis is based on simple clinical examination. Usually, leukemia presents with bleeding, weight loss, lymphadenopathy, fever, and frequent infection. Tonsillitis is a rare first presentation of leukemia. We present 3 cases in which the diagnosis of leukemia was made on routine examination, and in 1 case diagnosis was suspected during tonsillectomy.

Pleomorphic adenoma of minor salivary gland with therapeutic misadventure: a rare case report.

BACKGROUND: The benign tumors of nasopharynx are least encountered tumors in otolaryngology, as nasopharynx is considered one of notorious anatomical site for the malignant tumors. Pleomorphic adenoma of the minor salivary gland of nasopharynx and parapharyngeal space is rare. We present a pleomorphic adenoma of minor salivary gland which was mismanaged. CASE PRESENTATION: An adult male presented with left nostril obstruction for five months. The examination found big mass extending from nasopharynx to oropharynx. On CT scan, this tumor was quite big and extending to the parapharyngeal space. The FNAB found it a carcinoma but it did not respond to radiotherapy. The excision biopsy of tumor revealed it as pleomorphic adenoma. We found only five published reports on this tumor arising from nasopharynx. DISCUSSION AND CONCLUSION: Although, in this case report exact origin of the tumor could not be ascertained as it also appeared to be a parapharyngeal tumor but we kept the possibility of a nasopharyngeal tumor on the basis of clinical features. The pleomorphic adenoma of nasopharynx is rare. It can be misdiagnosed as malignant epithelial tumor on histopathology. The differentiation from its malignant variant is also difficult. A possibility of benign tumor should always be kept in nasopharyngeal growth with no evidence of metastasis, and histopathological diagnosis of growth should be available before any definitive treatment.

Primary non-Hodgkin's lymphoma of the infratemporal fossa: a rare case report.

BACKGROUND: The head and neck are two of the most common sites of extranodal non-Hodgkin's lymphoma (NHL). However, primary tumors of the infratemporal fossa are infrequent, and NHL in this region is extremely rare. CASE PRESENTATION: We present a case of a 41-year-old female that presented with swelling in the right preauricular region that had persisted for the past two years. The patient was diagnosed as having a small lymphocytic NHL. She initially underwent chemo-radiation but reported relapse. The tumor was excised and again the patient underwent chemotherapy. The patient remained symptomatic and developed a second primary squamous cell carcinoma in the right retromolar trigone. DISCUSSION AND CONCLUSION: We discussed NHL with an emphasis on extranodal manifestations. Extranodal NHL that is limited to a single site can be managed by surgery and regular follow up. To the best of our knowledge, this is only the second case of primary NHL of the infratemporal fossa to be reported in the literature.

Type-3 Gaucher disease with bilateral necrosis of the neck of femur: a case report.

INTRODUCTION: Though Gauchers disease (G.D.), a lipid storage disease is most commonly encountered by the hematologist but we present a case of G.D. type-3 which is rare in Indian subcontinent. CASE PRESENTATION: A 36-year-old Hindu, Indian male patient presented with bony pain, kyphosis, dragging sensation in the abdomen, dementia and ptosis of the left eyelid for one year. Clinical examination and history pointed to be a lipid storage disease. Radiological examination showed bilateral necrosis of the neck of femur. A final diagnosis of G.D. type-3 with bilateral necrosis of the femur neck was reported after examining the bone marrow smears. Unfortunately, we were unable to do the enzyme study as the patient was lost in the follow-up. CONCLUSION: G.D. type-3 with bilateral necrosis of femur neck is rare in our sub-continent. We are adding a new case to stress the importance of early recognition by clinical manifestation and finding of G.C. which is hallmark in the diagnosis of G.D.

Metastatic adenoid cystic carcinoma of lung: a case report.

A 48 year old male patient, operated five years back for sub mandibular swelling proved on histopathologic examination to be adenoid cystic carcinoma presented in the ENT department, I. G. medical hospital with pain on both sides of the chest. CT scan of the chest showed multiple lesions of variable sizes. CT guided FNAC as well as biopsy of the lung lesion was performed. Cytodiagnosis and histopathological examinations revealed features of cribiform type of adenoid cystic carcinoma. This case is reported here for its metastasis to the lungs and prolonged survival even with multiple metastasis.

FNA of cutaneous juvenile xanthogranuloma--a case report.

A case of cutaneous juvenile xanthogranuloma of the left shoulder in a three years old female which was diagnosed by FNA is presented here. Juvenile xanthogranuloma is a benign lesion of fibrohistiocytic proliferation, often regresses spontaneously, is a self-limiting lesion and should be treated conservatively.

FAB classification of leukemia: a cytochemical study.

The reproducibility of FAB classification for acute leukemia was assessed using the modified criteria of the FAB classification. Peripheral smears and bone marrow smears from 36 cases of acute leukemia stained with May-Graunwald-Giemsa were used for this purpose. Cytochemical stains used for this purpose were myeloperoxidase (MPO), Sudan Black B (SBB), Periodic acid Schiff's (PAS) and Alpha-naphthyl acetate esterase (ANAE). The concordance with morphology alone was 75% which improved to 92% when cytochemistry was included.