RESUMO
Primary mucinous cystic neoplasms are rare tumours of the kidney, with a very few case reports in the literature. They arise from metaplasia of renal pelvic urothelium. We describe here a 45-year-old male who presented with pain in the abdomen and a lump in the left iliac fossa for two months. Ultrasound and CT scan showed a large, complex, heterogenous mass in the central abdomen and left iliac fossa, suggesting the possibility of dermoid cyst. Excision of the mass showed an enlarged multicystic kidney filled with mucin, destruction of renal parenchyma and a small viable area of grey white tumour. Histopathology revealed a peripherally located mucinous cystadenocarcinoma arising in the background of chronic pyelonephritis and mucinous metaplasia. We report this case for the rarity of the lesion and the associated clinical and radiological diagnostic dilemma.
Assuntos
Coristoma/patologia , Cistadenocarcinoma Mucinoso/patologia , Pelve Renal/patologia , Rim , Neoplasias Retroperitoneais/patologia , Cisto Dermoide/patologia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Pielonefrite/diagnósticoRESUMO
Endometriosis of abdominal wall scar following operation on uterus and tubes is extremely rare. The late onset of symptoms after surgery is the usual cause of misdiagnosis. Scar endometriosis is a rare disease which is difficult to diagnose and should always be considered as a differential diagnosis of painful abdominal masses in women. The diagnosis is made only after excision and histopathology of the lesion. Preoperative differentials include hernia, lipoma, suture granuloma or abscess. Hence an awareness of the entity avoids delay in diagnosis, helps clinicians to a more tailored treatment and also avoids unnecessary referrals. We report a case of abdominal endometriosis. The definitive diagnosis of which was established by histopathological studies.
Assuntos
Parede Abdominal/patologia , Cesárea/efeitos adversos , Cicatriz/patologia , Endometriose/patologia , Adulto , Feminino , HumanosRESUMO
Papillary cystadenocarcinoma involving the salivary glands is rare, and there are only about 13 case reports and a single large series of 57 cases in the literature. We report 2 cases of this rare entity with emphasis on the diagnostic histomorphological features. The cases are also distinctive, in that they have an epithelial lining, which is oncocytic throughout. One of our cases was detected in an 8-year-old male child, which is itself a rarity.
Assuntos
Cistadenocarcinoma Papilar/secundário , Células Oxífilas/ultraestrutura , Neoplasias das Glândulas Salivares/patologia , Adenoma Oxífilo , Criança , Cistadenocarcinoma Papilar/cirurgia , Humanos , Linfonodos/patologia , Masculino , Pessoa de Meia-Idade , Mitocôndrias/ultraestrutura , Glândula Parótida/patologia , Neoplasias das Glândulas Salivares/cirurgia , Glândula Submandibular/patologiaRESUMO
AIM: To assess 25-hydroxyvitamin D (25OHD) concentrations in patients with primary hyperparathyroidism and to study the relationship, if any, between vitamin D concentration and bone disease. METHODS: Consecutive patients with diagnosed primary hyperparathyroidism were enrolled in the study. Clinical and biochemical details, including serum calcium, phosphate, alkaline phosphatase, parathyroid hormone (PTH) and 25OHD levels, were recorded. An abbreviated skeletal survey and preoperative localisation with ultrasound/CT scan of the neck and tetrofosmin/technetium-99m hexakis(2-methoxyisobutylisonitrile) parathyroid scan was performed. RESULTS: 39 patients with primary hyperparathyroidism were identified (mean (SD) age 38.4 (15.0) years (range 12-72)). The most common presenting features were bone pain (80%), fatigue (80%) and proximal muscle weakness (78%). Brown tumours were present in 58% of cases, renal calculi in 42% and nephrocalcinosis in 12%. The mean (SD) corrected serum calcium concentration was 12.47 (1.58) mg/dl (3.2 (0.4) mmol/l). Serum 25OHD concentration was <5 ng/ml in 11 patients (28%), 5-10 ng/ml in nine (23%), 10-20 ng/ml in 14 (36%), and >20 ng/ml in five (13%). Serum alkaline phosphatase, PTH and gland weight were higher, whereas serum 25OHD was lower, in patients with skeletal disease. Patients with 25OHD concentrations Assuntos
Doenças Ósseas/complicações
, Cálcio/sangue
, Hiperparatireoidismo Primário/complicações
, Deficiência de Vitamina D/complicações
, Vitamina D/análogos & derivados
, Adolescente
, Adulto
, Idoso
, Fosfatase Alcalina/sangue
, Criança
, Feminino
, Humanos
, Hiperparatireoidismo Primário/sangue
, Índia
, Masculino
, Pessoa de Meia-Idade
, Tamanho do Órgão
, Glândulas Paratireoides/anatomia & histologia
, Vitamina D/sangue
RESUMO
A case of Actinomycosis affecting the transverse colon masquerading as an abdominal neoplasm with perforation to abdominal parietal wall is presented. Abdominal actinomycosis lesions may present as a perforated abdominal neoplasm requiring emergency laparotomy. This case report highlights the diagnostic dilemma and the management algorithm for such infections.
Assuntos
Actinomicose/diagnóstico , Doenças do Colo/diagnóstico , Neoplasias do Colo/diagnóstico , Perfuração Intestinal/diagnóstico , Adulto , Colo/patologia , Doenças do Colo/microbiologia , Neoplasias do Colo/complicações , Feminino , Humanos , Mucosa Intestinal/patologiaRESUMO
Castleman's disease is an atypical lymphoproliferative disorder having two types of presentation--the localized and the multicentric form. The localized form presents as a slowly growing mass with a relatively benign course. Multicentric Castleman's disease has a more aggressive clinical course with diffuse lymph node enlargement and systemic illness. It is rarely seen in childhood and only thirteen cases have been reported in literature. This is the first report of 2 cases from the Indian subcontinent with a maximum follow-up of 44 months one of whom had asplenia.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Hiperplasia do Linfonodo Gigante/tratamento farmacológico , Hiperplasia do Linfonodo Gigante/patologia , Biópsia por Agulha , Criança , Seguimentos , Humanos , Imuno-Histoquímica , Masculino , Prednisolona/uso terapêutico , Medição de RiscoRESUMO
Angiogenesis plays an important role in the pathogenesis of haematological neoplasms and may be correlated with the prognosis. We recently evaluated the microvessel densities in trephine biopsy sections of seventeen patients of myelodysplastic syndromes (MDS). Of the 17 cases, 2 were RAEB-t, 3 were RAEB, one was RARS and 11 were of the subtype RA (FAB subtyping). The microvessel counts were measured in the bone marrow biopsy sections by immunohistochemical staining, using CD34 reactive monoclonal antibodies. MVD was significantly higher in the cases of RAEB and RAEB-t as compared to the cases of RA. The average MVD per x400 in the cases of RA was 5.7 +/- 4.7 with a median value of 4.65 (range 19) whereas it was 45.4 +/- 10.0 and 44.0 (range 27.3) respectively in RAEB and RAEB-t (p <.001), the 95% confidence interval being (2.94, 8.5) and (36.6, 54.3), for the two groups respectively. This finding may imply that subtypes of MDS with a higher tendency for converting to acute leukaemia are associated with increased angiogenesis as compared to other subtypes where the risk of progression to acute leukaemia is much lower.
Assuntos
Síndromes Mielodisplásicas/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Índia , Masculino , Microcirculação/patologia , Pessoa de Meia-Idade , Síndromes Mielodisplásicas/classificação , Neovascularização PatológicaRESUMO
Malignancy is the most common cause of tracheoesophageal fistulas. The malignancies commonly implicated in the development of tracheoesophageal fistulas are primary bronchial or esophageal carcinomas. Hodgkins disease rarely leads to such a fistula. We report a case of Hodgkin's disease with a tracheoesophageal fistula as well as a left recurrent nerve palsy at presentation. This presentation has no precedent in literature. The patient was treated with systemic chemotherapy and involved field radiotherapy. On follow up 1 year after the completion of treatment, he was clinically and radiologically disease free.
Assuntos
Doença de Hodgkin/diagnóstico , Nervo Laríngeo Recorrente/patologia , Fístula Traqueoesofágica/diagnóstico , Paralisia das Pregas Vocais/diagnóstico , Adulto , Doença de Hodgkin/fisiopatologia , Humanos , Masculino , Recidiva , Fístula Traqueoesofágica/fisiopatologia , Paralisia das Pregas Vocais/fisiopatologiaRESUMO
Mycetoma is a chronic suppurative infection involving the skin, subcutaneous tissue and bone. The hallmark of mycetoma is tumefaction, draining sinuses and the presence of microcolonies called grains. Sinuses develop in all patients with mycetoma within a year of the appearance of the lesion. The following case is reported as no sinuses had developed despite the presence of the lesion for 9 years, posing a diagnostic dilemma.
Assuntos
Micetoma/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Micetoma/patologiaRESUMO
We report an 11-year-old child who presented with an abdominal lump and was diagnosed as having an extragonal primary mesenteric seminoma. Patient was treated with 4 cycles of combination chemotherapy cisplatin, etoposide and bleomycin; he is now disease free for 2 years. We discuss and review extragonadal germ cell tumors arising from the mesentery and their management.
Assuntos
Mesentério , Neoplasias Peritoneais/diagnóstico , Seminoma/diagnóstico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bleomicina/uso terapêutico , Criança , Cisplatino/uso terapêutico , Etoposídeo/uso terapêutico , Humanos , Masculino , Neoplasias Peritoneais/terapia , Seminoma/terapiaRESUMO
Lymphocytic hypophysitis commonly occurs in females in peripartum period but several unusual presentations have been reported. Here we report a rare case of recurrent lymphocytic hypophysitis in a woman who had subtotal adrenalectomy for hypercortisolism 27 years back. Polyglandular autoimmune endocrinopathy with an uncommon combination of Cushing's syndrome and recurrent hypophysitis is a strong possibility in this case. Treatment with steroids has been found to have beneficial effect.
Assuntos
Adrenalectomia , Síndrome de Cushing/cirurgia , Transtornos Leucocíticos/diagnóstico , Doenças da Hipófise/diagnóstico , Síndrome de Cushing/complicações , Feminino , Humanos , Inflamação/diagnóstico , Inflamação/etiologia , Inflamação/terapia , Transtornos Leucocíticos/etiologia , Transtornos Leucocíticos/terapia , Pessoa de Meia-Idade , Doenças da Hipófise/etiologia , Doenças da Hipófise/terapia , RecidivaRESUMO
Acute lymphoblastic leukemia (ALL) can occasionally relapse in unusual extramedullary sites like bone. Here we present a 6.5-year old boy with 'T' cell ALL who developed a swelling in left tibia which was infiltrated with lymphoblasts 7 months after completion of chemotherapy. Bone marrow and cerebrospinal fluid were negative for blasts. This is the first reported case of bone relapse in ALL from India. We discuss the previous cases of isolated bone relapse in ALL reported in English literature.
Assuntos
Leucemia-Linfoma Linfoblástico de Células Precursoras/patologia , Tíbia/patologia , Osso e Ossos/patologia , Pré-Escolar , Humanos , Masculino , RecidivaRESUMO
OBJECTIVE: This study was done to assess goitre prevalence, thyroid functional status and cause of residual goitre among school children in the postsalt iodization phase in India. DESIGN: A cross-sectional study in which, 14762 school children in the age group of 6-18 years, from different States and Union territories of India, were evaluated for goitre prevalence, urinary iodine and thiocyanate excretion, functional status of the thyroid as well as serological and cytopathological markers for thyroid autoimmunity. MEASUREMENTS: Urinary iodine (wet ashing method), urinary thiocyanate (colourimetric method), serum thyroxine [in-house radioimmunoassay (RIA)], serum TSH (IRMA), antithyroid microsomal and antithyroglobulin antibodies (haemagglutination method) were estimated. Fine-needle aspiration cytology was performed in all goitrous subjects giving consent. RESULTS: The overall goitre prevalence was 23% (27.1% girls; 17.8% boys, P < 0.001). Subjects belonging to poor socio-economic strata had significantly higher goitre prevalence. Median urinary iodine excretion (UIE) in goitrous subjects (2-53 micromol/l) was significantly higher than in controls (2-24 micromol/l; P < 0.001). Levels of UIE observed among goitrous subjects showed no relationship with the presence or absence of thyroid dysfunction or with thyroid antibody status. High titres (> or = 1:1600) of TMA were present more often in goitrous subjects (6.08%) than nongoitrous controls (0.34%; P < 0.001) and in girls (7.3%) than boys (2.35%; P < 0.001). TMA positivity were significantly more among goitrous subjects with thyroid dysfunction than in euthyroid subjects. Significantly higher median urinary thiocyanate (USCN) excretion was observed in goitrous subjects (0.75 mg/dl) compared to controls (0.64 mg/dl; P < 0.001) and goitrous girls compared to goitrous boys. USCN excretion of goitrous subjects and controls showed no relationship with functional or thyroid antibody status in various groups. CONCLUSIONS: Persistent, albeit reduced prevalence of goitre, despite adequate iodine prophylaxis, suggests existence of additional factors in goitrogenesis in India. Thyroid autoimmunity can explain only a part of the goitre prevalence. The role of goitrogens in residual goitre prevalence is brought forth.
Assuntos
Bócio/prevenção & controle , Iodo/administração & dosagem , Cloreto de Sódio na Dieta/administração & dosagem , Adolescente , Distribuição por Idade , Autoanticorpos/sangue , Causalidade , Criança , Estudos Epidemiológicos , Feminino , Bócio/epidemiologia , Bócio/imunologia , Humanos , Índia/epidemiologia , Iodo/urina , Masculino , Microssomos/imunologia , Estado Nutricional , Pobreza , Distribuição por Sexo , Estatísticas não Paramétricas , Tiocianatos/urina , Glândula Tireoide/imunologia , Glândula Tireoide/fisiopatologiaRESUMO
Laparoscopy assisted hemicolectomy for ileo-caecal tuberculosis is being evaluated the world over. Several procedures are performed laparoscopically, including the laparoscopic hemicolectomy, for benign and malignant diseases. Abdominal tuberculosis is one of the commonest causes of intestinal obstruction in India. We have evaluated the role of laparoscopic resection of ileocaecal tuberculosis and successfully performed the procedure in five patients. The clinical profiles of patients and operative procedure are discussed in this article with a brief review of the literature.
Assuntos
Doenças do Ceco/cirurgia , Colectomia/métodos , Doenças do Íleo/cirurgia , Laparoscopia/métodos , Tuberculose Gastrointestinal/cirurgia , Adulto , Sulfato de Bário , Doenças do Ceco/diagnóstico por imagem , Enema , Feminino , Seguimentos , Humanos , Doenças do Íleo/diagnóstico por imagem , Masculino , Radiografia , Resultado do Tratamento , Tuberculose Gastrointestinal/diagnóstico por imagemRESUMO
Computerized image analysis (IA) system has emerged in recent years as a very powerful tool for objective and reproducible quantification of histological features. It has shown considerable potential for diagnostic application in diverse histological situations. The objectives of the present study were to evaluate the discriminatory diagnostic efficiency of computerized image analysis based quantitative subvisual nuclear parameters in papillary and follicular neoplasms of thyroid. A total of 60 cases were studied. Forty-four cases belonged to training set and 16 cases belonged to a test set. A minimum of 100 nuclei was analyzed in each case using uniform 5 m mm thick hematoxylin stained sections. The IA workstation comprised of an Olympus microscope, a 10 bit digital video camera, an image grabber card and a pentium 120 MHz computer. Optimas 5.2 software was utilized for data collection on 8 morphometric and 8 densitometric parameters. Multivariate stepwise discriminant statistical analysis of data was done with the help of BMDP statistical software release 7.0. Results from a training set revealed correct classification rates of 98.0%, 84.5% and 61.2% for the histological groups of hyperplastic papillae versus papillae of papillary carcinoma (group I), follicular variant of papillary carcinoma versus the broad category of follicular neoplasms consisting of both follicular adenoma and follicular carcinoma (group II) and follicular adenoma versus follicular carcinoma (group III), respectively. Results of test set revealed correct classification rates of 100%, 80% and 50% for groups I, II and III respectively. It was concluded that computerized nuclear IA parameters have potential usefulness for discriminating benign versus malignant papillary lesions of thyroid, follicular variant of papillary carcinoma versus follicular adenoma and/or follicular carcinoma but are of no value in discriminating between follicular adenoma and follicular carcinoma.
Assuntos
Adenocarcinoma Folicular/diagnóstico , Adenoma/diagnóstico , Carcinoma Papilar/diagnóstico , Diagnóstico por Computador , Processamento de Imagem Assistida por Computador/métodos , Neoplasias da Glândula Tireoide/patologia , Núcleo Celular/patologia , Humanos , Inclusão em Parafina , Estudos RetrospectivosRESUMO
Fine-needle aspiration cytology (FNAC) is considered highly specific for the diagnosis of papillary carcinoma of the thyroid (PCT). In recent years, several variants of PCT have been described. An attempt was made to gauge the accuracy of classification of variants of PCT on aspirates. Cytology smears from 124 of 150 cases of histologically proven PCT with a prior FNAC were reviewed over a 16-yr period. A diagnosis of papillary carcinoma on FNAC was made in 93 cases. Further subclassification of these cases was done on cytology and tissue sections independently. The variants of PCT classified on FNAC were classical PCT (PCT-CL), 76 cases; Hurthle-cell variant (PCT-HCV), 3 cases; follicular variant (PCT-FV), 6 cases; tall-cell variant (PCT-TCV), 2 cases; high-grade variant (PCT-HG), 2 cases; and 2 cases each which were debatably PCT-CL/PCT-FV and PCT-CL/PCT-HG. Cytology typing was accurate in 65 of the 72 classical variants, while only 7 of the 22 follicular variants were correctly identified on cytology. Two of the 3 high-grade papillary carcinomas (PCT-HG) were identified on FNAC, and the solitary case of tall-cell variant could readily be classified on cytology. In conclusion, identification of the various variants of PCT is possible, though difficulty is encountered in correctly categorizing the follicular variant, which is often mistaken for a follicular neoplasm. Also, identification of the solid variant and the papillary carcinoma with nodular fasciitis-like stroma was a problem on cytology. Another interesting observation in our series is that an admixture of various cell types was seen in the smears and corroborated on histology to be present in focal areas.
Assuntos
Carcinoma Papilar/patologia , Neoplasias da Glândula Tireoide/patologia , Biópsia por Agulha , Carcinoma Papilar/classificação , Humanos , Neoplasias da Glândula Tireoide/classificaçãoRESUMO
Myxoma is an uncommon neoplasm in the head and neck region. Laryngeal myxomas are rarer still. We report a case of a large myxoma in the supraglottis, that was excised endoscopically.
Assuntos
Neoplasias Laríngeas/cirurgia , Laringoscopia/métodos , Mixoma/cirurgia , Humanos , Neoplasias Laríngeas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Mixoma/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
This is a study of 64 cases of recurrent astrocytic tumors of all four WHO grades wherein a comparative evaluation of initial vs. recurrent tumor was done with respect to histological grading, MIB-1 labeling index (LI) and apoptotic index (AI). The aim was to identify factor/s that could influence interval to recurrence and/or malignant progression. Recurrence was noted in all grades and upon recurrence, 93.3% of grade II (low grade diffuse) astrocytomas and 63.6% of grade III anaplastic astrocytomas underwent malignant progression. However, none of the Grade I tumors showed evidence of malignant progression. Though interval to recurrence varied considerably, there was a correlation with histological grade of the initial tumor in that grade I and II tumors had a significantly longer mean interval to recurrence (43 months and 54.8 months respectively) as compared to grade III and IV (glioblastoma multiforme) tumors (17.6 and 12.8 months respectively). The interval to recurrence was also longer for grade II and III tumors which showed progression on recurrence (55.3 months for Grade II->Grade III; 54 months for Grade II->Grade IV and 20.6 months for Grade III->IV) as compared to tumors which recurred to the same grade (12.5 months for Grade III->Grade III and 12.8 months for Grade IV->Grade IV). A statistically significant inverse correlation of MIB-1 LI with interval to recurrence was noted. Higher the MIB-1 LI, shorter was the interval to recurrence. Further a cut off MIB-1 LI value of 2.8% could be proposed in predicting recurrence free survival. Interestingly, MIB-1 LI of grade II tumors, which had progressed to grade IV was significantly higher than MIB-1 LI of grade II tumors which had progressed to grade III. Thus, this study establishes the potential role of MIB-1 LI of the initial tumor in determining interval to recurrence. However, apoptotic index has no role in predicting either interval to recurrence or malignant progression.