Clinicopathological pattern of cranial unifocal Langerhans cell histiocytosis: A study at medical college hospital.

BACKGROUND: Eosinophilic granuloma (EG) of bone refers to a generally benign form of Langerhans cell histiocytosis localized to the bone. Patients may present with a solitary lesion (monostotic) or multiple sites of involvement (polyostotic). MATERIALS AND METHODS: This study was done to evaluate the clinicopathological pattern of 6 cases of EGs of the skull diagnosed at a tertiary care hospital. All patients of EG were included with the help of medical records over a 5-year period that is, November 2009 to November 2014. They all had been preoperatively evaluated by skull X-ray and computed tomography. To rule out a multifocal disease scintigraphy was performed in all cases preoperatively. Surgical excision was performed, and EG was diagnosed on histopathology and immunohistochemistry. RESULTS: There was a male predominance. Parietal bone was the most common affected bone. Total excision of the lesion was performed in all cases. No patient received postoperative radiotherapy. The follow-up period ranged from 6 months to 3 years. No tumor recurrence was noted. CONCLUSION: With an unknown etiology, nonspecific clinical and radiological findings with diagnosis possible only on histopathological examination, EG needs to be considered in the differential diagnosis as a skull mass, especially in children.

Intracranial neurenteric cyst: A rare cause of chemical meningitis.

Intracranial neurenteric cysts are exceedingly rare congenital intracranial lesions that result from disorder of gastrulation. Still, more rarely, the cyst contents may leak into the CSF and give rise to recurrent episodes of chemical meningitis. We present a case of chemical meningitis due to a leaking posterior fossa neurenteric cyst in a young female, with emphasis on its imaging features. The final diagnosis was achieved by sufficiently characteristic imaging features; histopathologic documentation could not be achieved as the patient denied surgery.

Spontaneous hepatic subcapsular biloma: Report of three cases with review of the literature.

A biloma is an encapsulated bile collection outside the biliary tree. Most cases are caused mainly by iatrogenic injury and trauma, and are usually located in the sub-hepatic space. Spontaneous biloma is an uncommon entity. We report three rare cases of spontaneous hepatic subcapsular biloma formation in association with choledocholithiasis in two patients and cholangiocarcinoma in one patient. All the patients presented with extrahepatic biliary obstruction with no previous history of abdominal surgery, instrumentation, or trauma. Ultrasound and computerized tomography of the abdomen documented hepatic subcapsular biloma. The patients were initially managed with antibiotics and radiologically guided pigtail drainage of the collections, followed by definitive treatment of their underlying cause.

Primary isolated echinococcal cyst of the seminal vesicle: A rare case.

Hydatid disease of the organs other than liver and lung is extremely rare. Although hydatid disease is endemic in India, we report a rare case of hydatid cyst in a young male primarily involving the seminal vesicle and aim to highlight the management of such cases. A 23 year old male farmer diagnosed with primary isolated echinococcal cyst of the seminal vesicle has been presented. Thorough investigations with radiological methods such as ultrasonography (abdominal and trans-rectal), and magnetic resonance imaging were carried out to aid in the diagnosis. Surgical excision of the lesion was carried out with careful removal of the cyst to prevent any bursting and spillage, leaving the seminal vesicle preserved. The cystic lesion was subjected to histopathological examination. Histopathology confirmed the diagnosis of hydatid disease. Postoperative period was uncomplicated and patient was discharged on seventh postoperative day. Patient was put on albendazole (10 mg/kg/day) for three cycles of 21 days each with a gap of one week between each cycle. There was no evidence of recurrence or development of cysts elsewhere in the body during the 2 year follow-up. Hydatid cyst of seminal vesicle is rare and should be kept in differential diagnosis of a cystic lesion in pelvis especially in regions where hydatid disease is endemic. Proper surgical and medical management to avoid any recurrences, and a regular follow-up, are of utmost importance to detect any late complications such as local recurrence of the disease and development of hydatidosis at the primary sites.

Central pancreatectomy: a new technique for resection of selected pancreatic tumors.

BACKGROUND: Pancreatic tumors located in the neck region usually require pancreaticoduodenectomy or splenopancreatectomy. For small benign tumors enucleation is not usually feasible due to their size and localization; then pancreatectomy is often needed. Central pancreatectomy consists of a limited resection of the midportion of the pancreas and can be offered in benign and low-grade malignant tumors of the neck of the pancreas. The study aimed to evaluate whether central pancreatectomy has a place in pancreatic surgery. METHODS: In this study, which covered a period of 14 months, we performed central pancreatectomy in four selected patients. Preoperative evaluation and operative frozen section biopsy in indicated cases allowed proper selection for the procedure. Operative details, complications and follow-up were recorded. RESULTS: Four patients, two with serous cystadenoma, and one with an islet cell tumor, and one with a hydatid cyst, were identified for the procedure. The mean tumor size was 3 cm, the mean operative time was 217.5 minutes, and the mean blood loss was 382.5 ml. There was no morbidity or mortality in this series. No endocrine or exocrine deficiency was observed in any patient during a mean follow-up of 22.7 months. CONCLUSIONS: Central pancreatectomy is a procedure that offers excellent results in benign and low-grade malignant tumors. It preserves functional elements (endocrine and exocrine) of the pancreas and also eliminates the infective and hematological effects of splenectomy. Thus, central pancreatectomy should be included in the armamentarium of pancreatic surgery, and in order to obtain good results, proper indications and adequate experience are recommended.