S-100 Immuno-Positive Low Grade Myofibroblastic Sarcoma of Nasal Cavity: A Rare Case Presentation and Review of Literature.

Introduction: Myofibroblastic neoplasms comprise a spectrum of benign/malignant neoplasms. Only low-grade malignant forms have been reproducibly characterized as a diagnostic entity in the WHO classification. Low grade myofibroblastic sarcoma (LGMFS) confined to the nasal cavity is extremely rare. Objective: To review previously reported cases of nasal cavity LGMFS and provide a better insight regarding its clinical and immunohistochemical features. Data synthesis: A review was performed involving two databases (PubMed and Google Scholar). Four cases of nasal cavity LGMFS were included. The lesion showed no gender or nasal-side predilection. All cases underwent wide excision. None showed distant metastasis while half recurred locally. Histologically, mitotic rate ranged from 1 to 3/10 high-power-field (HPF) and none exhibited spontaneous necrosis. Immuno-expression of calponin, smooth muscle actin (SMA) and vimentin were seen in either all four or three-fourth of cases. Diffuse S-100 expression was a unique finding in present case and not reported previously, that caused a diagnostic dilemma with schwannomas. Conclusion: LGMFS of nasal cavity is extremely rare. A wide resection is the primary treatment of choice. Adjuvant therapies (chemotherapy or radiotherapy) are of uncertain significance. Distant metastasis is rather unusual. Calponin, SMA and vimentin are highly sensitive immuno-markers. Diffuse S-100 expression is a possible finding. Mitotic rate < 6/10 HPF and absence of spontaneous necrosis are characteristic indolent features differentiating from high grade lesions. Trifecta of clinical and morphological features plus immunohistological phenotype, are sufficient for a definitive diagnosis. Electron microscopy is the most definitive confirmation test, however, should be reserved only for equivocal/atypical immunostaining pattern.

Emergence of Invasive Fungal Rhinosinusitis in Recently Recovered COVID-19 Patients.

OBJECTIVE: The risk of invasive fungal rhinosinusitis is increased in Coronavirus disease 2019 (COVID-19) because of its direct impact in altering innate immunity and is further exacerbated by widespread use of steroids/antibiotics/monoclonal antibodies. The study aims to describe this recently increased clinical entity in association with COVID-19. METHOD: A prospective, longitudinal study including patients diagnosed with acute invasive fungal rhinosinusitis (AIFRS) who recently recovered from COVID-19 infection or after an asymptomatic carrier state. A single-center, descriptive study investigating demographic details, clinical presentation, radio-pathological aspects, and advocated management. RESULT: A total of 21 patients were included with a mean age of 49.62 years (SD: 14.24). Diabetes mellitus (DM) was the most common underlying disorder (90.48%), and 63.16% of all patients with DM had a recent onset DM, either diagnosed during or after COVID-19 infection. Nineteen patients (90.48%) had recently recovered from active COVID-19 infection, and all had a history of prior steroid treatment (oral/parenteral). Remaining 2 patients were asymptomatic COVID-19 carriers. Surprisingly, 2 patients had no underlying disorder, and 5 (23.81%) recently received the Covishield vaccine. Fungal analysis exhibited Mucor (95.24%) and Aspergillus species (14.29%). Most common sign/symptom was headache and facial/periorbital pain (85.71%), followed by facial/periorbital swelling (61.90%). Disease involvement: sinonasal (100%), orbital (47.62%), pterygopalatine fossa (28.58%), infratemporal fossa (14.29%), intracranial (23.81%), and skin (9.52%). Exclusive endoscopic debridement and combined approach were utilized in 61.90% and 38.10%, respectively. Both liposomal amphotericin B and posaconazole were given in all patients except one. CONCLUSION: A high suspicion of AIFRS should be kept in patients with recent COVID-19 infection who received steroids and presenting with headache, facial pain, and/or facial swelling. Asymptomatic COVID-19 carriers and COVID-19 vaccinated candidates are also observed to develop AIFRS, although the exact immuno-pathogenesis is still unknown. Prompt diagnosis and early management are vital for a favorable outcome.

Ectopic Deciduous Maxillary Tooth in the Nasal Cavity Following Trauma.

Several cases of the ectopic supernumerary tooth in the nasal cavity have been reported; however, an eruption of the primary maxillary tooth in the nose following trauma is extremely rare. Clinical evaluation and discriminating features on CT imaging, particularly with bone window setting, are sufficient to confirm the diagnosis. We discuss a case of deciduous central maxillary incisor in the nasal cavity and specifically focus on its clinical and radiological presentation. None of the previous authors have discussed probable theories of the post-traumatic intranasal tooth; we consider two possible theories which might be responsible for the ectopic intranasal tooth after trauma. Additionally, we discuss pertinent features which help distinguish ectopic deciduous tooth from the supernumerary tooth.

Percutaneous Radiofrequency Ablation of Appendicular Skeleton Chondroblastoma-an Experience from a Tertiary Care Cancer Center.

PURPOSE: To evaluate safety and long-term efficacy of radiofrequency (RF) ablation in treatment of chondroblastoma. MATERIALS AND METHODS: This retrospective analysis comprised 27 consecutive patients with histopathologically proven chondroblastoma treated by RF ablation. The tumors were located in the proximal humerus (n = 6), proximal tibia (n = 8), proximal femur (n = 6), distal femur (n = 5), acromion process (n = 1), and lunate (n = 1). In 19 patients (70.3%), the tumor was in the weight-bearing area of the bone. Clinical response was assessed by comparing pain scores and functional assessment by Musculoskeletal Tumor Society (MSTS) score before and after ablation. Patients were followed for a minimum of 1 year to rule out complications and recurrence. RESULTS: Technical success rate was 100%. Mean pain score before the procedure was 7.34 (range, 7-9); all patients experienced a reduction in pain, with 25 (92.6%) patients reporting complete pain relief at 6 weeks. Mean MSTS score before the procedure was 15.4, whereas mean MSTS score at 6 weeks after the procedure was 28.6, suggesting significant functional improvement (P < .0001). Two patients developed osteonecrosis and collapse of the treated bone. There were no recurrences. CONCLUSIONS: Percutaneous RF ablation is a safe and effective option for treating chondroblastoma of the appendicular skeleton.

Clinical Profile and Quality of Life Assessment of Oral Cancer Patients Following Nasolabial Flap Reconstruction Surgery.

To evaluate the quality of life (QOL) of oral cancer patients who had undergone surgical reconstruction with nasolabial flap. A cross-sectional study was conducted over a period of 1 year at a tertiary care hospital and 128 subjects were included. The subjective assessment of quality of life using The University of Washington QOL Questionnaire including physical, socio-emotional, composite and overall QOL, Objective assessment of functional mouth opening and Nasolabial crease scar assessment using Vancouver scar scale was done. Majority of the subjects, 98.4% were male. Maximum cases were involving the lower gingivobuccal complex and retromolar trigone followed by buccal mucosa. Majority of the tumors were T2, 53.1% followed by T1, 18.8%. Statistically significant (p < 0.05) difference was found in relation to age, tumor size (T1, T2, T3), absence of adjuvant radiation therapy, presence or absence of neck dissection, tumor site; buccal mucosa and lower gingivobuccal complex plus retromolar trigone and intact bone status in physical functional, social-emotional subscores, composite score and overall QOL assessment. Improved mouth opening postoperatively was statistically significant (p < 0.05) in T1 and T2 lesions of buccal mucosa and lower gingivobuccal complex plus retromolar trigone who did not receive radiation and with intact bone status. Majority of the cases, 36.7% had a nasolabial crease scar score 2. Nasolabial flap is a viable option in the reconstruction of small and medium sized oral defects with good quality of life (QOL) outcome and objective outcome as depicted by significantly improved mouth opening. The aesthetic outcome of nasolabial crease scar is good in our study.

Risk Indicators for Hearing Impairment in Neonates.

To identify relation between prevalence of hearing impairment and risk factors at the time of birth in high risk neonates. A year-long study is performed at HBT Medical College and Dr. R. N. Cooper Municipal General Hospital, Vile Parle (west), Mumbai. The Study comprised of 478 high risk babies born between March 2016 and February 2017 and admitted in NICU of the hospital. Out of these 68 babies were either transferred to higher centre or took discharge against medical advice. A total of 410 babies completed the study. Additional 21 eligible babies died in NICU during the study. A Prospective Observational Study is used to analyse the findings of the study. Skew analysis of spread of prevalence across risk factors is used to establish higher prevalence of hearing impairment in high risk neonates. Cramer's Moment Coefficient of Skewness and Corresponding Test Statistics are used for studying the skewness. Out of 410 babies screened during the study 5 babies were diagnosed with profound SNHL. The risk factors associated with babies is plotted against frequency of babies with Profound SNHL. The plot is found to be un-uniformly distributed and shows inclination towards higher prevalence with high risk babies. Sample skewness (G1) value - 0.81 indicates moderately negative skewed sample. This means the number of babies with profound SNHL found by 3 stage screening is moderately concentrated at high risk weightage.